A Comparative Study on the Efficacy, Safety and Cost Effectiveness of Gabapentin and Pregabalin in the Treatment of Neuropathic Pain
Notice bibliographique
Résumé
Introduction Neuropathic pain distinguishes itself from nociceptive pain not only in its etiology and clinical presentation but also in its limited responsiveness to non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. Gabapentin and pregabalin, collectively referred to as gabapentinoids, are anticonvulsant agents that have demonstrated efficacy in managing neuropathic pain. Evidence supports their use in comparison to placebo or antidepressants, such as tricyclic antidepressants, for the treatment of neuropathic pain. However, despite extensive investigation, there remains a paucity of conclusive data and often contradictory findings regarding the relative superiority of one drug over the other, particularly in resource-constrained settings and including the practicality of the money spent. Aim The aim of the study is to evaluate and compare the efficacy, safety parameters and cost-effectiveness of gabapentin (GB) and pregabalin (PG) in neuropathic pain. Methods A randomized double-blind comparative study was conducted to evaluate the effectiveness of GB and PG in the treatment of neuropathic pain, involving 60 patients attending the Neurology outpatient department (OPD) at Sri Ramachandra Institute of Higher Education and Research, Chennai. The participants were equally divided into two groups: Group A received GB and Group B received PG. Both groups were followed up regularly at four, eight, and 12 weeks. From day 0, doses were titrated according to the response and side effects, costs were noted down at each visit and pain was assessed using the Visual Analog Scale (VAS) and the McGill Pain Questionnaire. Results Both GB and PG demonstrate significant effectiveness in improving the symptoms of the patients after three months of treatment (2.5±0.9 for PG vs. 4.5±1.3 for GB, p<0.001) according to VAS, with a similar result when analysed with the McGill Pain Questionnaire. PG also has the advantages in terms of statistical results and evidence along with fewer reported adverse effects and better patient compliance.Cost evaluation indicated that the cumulative expense for PG over three months was INR 1,286 compared to INR 3,420 for GB, even with dose adjustments. Moreover, PG demonstrated a 75% reduction in cost per VAS point and a 72% decrease in cost per McGill point, highlighting its greater cost-effectiveness along with improved clinical results. Conclusion This randomized prospective study provides a comparison of the efficacy and safety of GB and PG in neuropathic pain, while throwing light into health economic part by including cost analysis. Such comparisons, including expense analysis, are limited in the literature. Our study plays a role in substantiating PG as a better analgesic in many respects for neuropathic pain while also proposing a possibility for evaluating combination therapies and to provide an optimize healthcare resource allocation.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».