A Meta-analysis of Randomized Controlled Trials Comparing the Efficacy and Safety of Pregabalin and Gabapentin in the Treatment of Postherpetic Neuralgia

Abstract

Objective To systematically evaluate the clinical efficacy of pregabalin and gabapentin in the treatment of postherpetic neuralgia (PHN), including the difference in pain control and occurrence of adverse reactions. Methods PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched for randomized controlled trials (RCTs) comparing the efficacy of pregabalin and gabapentin in patients with PHN. Data from studies meeting the inclusion criteria were extracted and the Cochrane Risk of Bias risk assessment tool was used to evaluate the quality of the included studies. Revman 5.3 and Stata17 were used to perform the meta-analysis and to detect publication bias. Results A total of 14 RCTs with 3545 patients were included in this study, including 926 in the pregabalin treatment group, 1256 in the gabapentin treatment group, and 1363 in the placebo control group. Pregabalin was better than gabapentin in alleviating pain and improving the global perception of change in pain and sleep ( P < 0.05). Gabapentin was associated with a lower incidence of adverse events than pregabalin ( P < 0.05). Funnel plot and Begg’s and Egger’s tests showed no significant publication bias. Conclusion Pregabalin appears to have a better overall therapeutic effect than gabapentin for patients with PHN, but gabapentin has a lower incidence of adverse reactions and a better safety profile. Clinicians should comprehensively consider patient factors and fully evaluate the advantages and disadvantages of each treatment option to select the most suitable drugs for patient use. Considering the limited quantity and quality of the existing literature, high-quality RCTs are needed to confirm the advantages of pregabalin over gabapentin in the treatment of PHN and guide clinical decision-making.

Investigational Drugs for the Treatment of Postherpetic Neuralgia: Systematic Review of Randomized Controlled Trials

“…Inhibitors such as gabapentin or pregabalin (gabapentinoids) have been used for its treatment for years [ 40 ], despite their initial indication being for the treatment of epilepsy [ 41 , 42 ]. Pregabalin, as mentioned, is a first-line treatment for PHN, and its superiority over gabapentin is demonstrated [ 43 ]. New dosage forms of pregabalin have been developed for improving adherence to treatment, such as controlled-release pregabalin [ 16 ].…”

Molecular Mechanisms and Therapeutic Potential of Gabapentin with a Focus on Topical Formulations to Treat Ocular Surface Diseases

“…Some studies show that gabapentin can be beneficial in managing neuropathic pain, with similar efficacy to pregabalin in the case of spinal cord injury [69,70] and chronic neuropathic pain [71]. In the case of post-herpetic neuralgia, pregabalin might work better for controlling PHN pain, but GBP may cause fewer side effects [72]. Similarly, GBP and pregabalin had similar analgesic effects in the treatment of ocular pain, after photorefractive keratectomy (PRK) [57] or chronic neuropathic ocular pain [73].…”

Novel Drug Targets and Emerging Pharmacotherapies in Neuropathic Pain

“…Cao et al performed the systematic review to compare the clinical efficacy of pregabalin and gabapentin in treating post-herpetic neuralgia and assessed the occurrence of adverse reactions [ 64 ]. In total, 14 randomized controlled trials involving 3545 patients were included in the study [ 64 ].…”

“…Cao et al performed the systematic review to compare the clinical efficacy of pregabalin and gabapentin in treating post-herpetic neuralgia and assessed the occurrence of adverse reactions [ 64 ]. In total, 14 randomized controlled trials involving 3545 patients were included in the study [ 64 ]. The findings showed that pregabalin was more effective than gabapentin in alleviating pain and improving global perception of pain and sleep [ 64 ].…”

“…In total, 14 randomized controlled trials involving 3545 patients were included in the study [ 64 ]. The findings showed that pregabalin was more effective than gabapentin in alleviating pain and improving global perception of pain and sleep [ 64 ]. However, gabapentin had a lower incidence of adverse events compared to pregabalin [ 64 ].…”