Comparison of Gabapentin and Ketotifen in Treatment of Uremic Pruritus in Hemodialysis Patients

Amirkhanlou, Saeid; Rashedi, Anna; Taherian, Jalal; Hafezi, Ali Akbar; Parsaei, Sahar

doi:10.12669/pjms.321.8547

Cited by 27 publications

(39 citation statements)

References 17 publications

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“…Two of these studies had crossover design comparing gabapentin to placebo and pregabalin . Five were parallel‐arm studies comparing gabapentin to placebo, and antihistamines such as hydroxyzine, ketotifen, and dexchlorpheniramine (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Ten centimeter or 100 mm pruritus visual analogue scale (VAS) was used in six studies, wherein subjects were trained to evaluate pruritus severity with 10 or 100 horizontal lines marked from 0 to 10 or 0 to 100 (0 stands for no pruritus and 10 or 100 stands for worst possible itch) . One study used Shiratori's pruritus severity scoring system, wherein 0 stands for no itching, 1 for minimal, 2 for mild, 3 for moderate, and 4 for severe itching …”

Section: Resultsmentioning

confidence: 99%

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Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

2019

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Uremic pruritus is one of the most prevalent and bothersome dermatologic symptoms in patients with end‐stage renal disease. Some studies suggest a possible neuropathic cause of uremic pruritus. Gabapentin, an anticonvulsant, may control pruritus with neuropathic origin. The objectives of this study were to assess the efficacy of gabapentin in reducing pruritus scores of patients with uremic pruritus and evaluate its safety among dialysis patients. Meta‐analysis of randomized controlled trials, using gabapentin as treatment for uremic pruritus among hemodialysis patients was included and analyzed using Review Manager Version 5.1.4 software. Seven out of 17 screened articles were included, with a total of 315 participants. Meta‐analysis of the incidence of improved pruritus scores after treatment from four studies (n = 171) showed that treatment with gabapentin decreased the severity of uremic pruritus as compared to the placebo (risk ratio = 0.18; 95% confidence interval: 0.09, 0.33; I2 = 4%: P =< 0.00001). Six studies (n = 290) presented with incidence of adverse drug events such as dizziness, drowsiness, and somnolence. In the pooled analysis, treatment with gabapentin was associated with a higher incidence of adverse drug events compared to the comparator drugs, but the results were not significant (risk ratio = 1.3, 95% confidence interval: 0.81, 2.11; P = 0.28, I2 = 37%). The results of this systematic review suggest that gabapentin is efficacious and safe in improving uremic pruritus among dialysis patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

2019

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“…Most nephrologists in all countries use antihistamines as first-line drug treatment. Treatment with the antihistamine ketotifen has been shown to reduce pruritus compared with conventional therapy (31), but in a comparative trial without a placebo arm, ketotifen was less effective than gabapentin (32). Another uncontrolled trial of ketotifen showed no effect on pruritus, and uncontrolled trials of hydroxyzine and chlorphenamine showed a partial effect or no effect (32).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with the antihistamine ketotifen has been shown to reduce pruritus compared with conventional therapy (31), but in a comparative trial without a placebo arm, ketotifen was less effective than gabapentin (32). Another uncontrolled trial of ketotifen showed no effect on pruritus, and uncontrolled trials of hydroxyzine and chlorphenamine showed a partial effect or no effect (32). Plasma histamine levels are not associated with the severity of pruritus (33), and patients frequently report that antihistamines are ineffective (11,21,34).…”

Section: Discussionmentioning

confidence: 99%

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

174

238

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Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally.Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012-2015 were analyzed to describe predictors, effects, medical directors' awareness, and treatment of pruritus.Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012-2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to health care staff. In total, 69% of medical directors underestimated the prevalence of pruritus in their unit. Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but no relationship was found between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus. Gabapentin was used by 45% as first-, second-, or third-line treatment. Nalfurafine was only used in Japan.Conclusions The prevalence of pruritus in people on hemodialysis is decreasing but remains underestimated. Large numbers of patients on hemodialysis with severe pruritus do not receive treatment. There is wide variation in the use of unlicensed medications for the treatment of pruritus. These data provide a benchmark for initiatives to improve the management of uremic pruritus.

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“…43 In a recent, double-blind, RCT of 52 HD patients comparing ketotifen to gabapentin, participants treated with ketotifen had a 76.9% reduction in pruritus severity after a 2-week treatment period. 80 However, there was no difference in efficacy between the gabapentin-and ketotifen-treated groups. Cromolyn sodium was found to improve pruritus in a case study of 2 HD patients.…”

Section: Antihistamine Treatmentmentioning

confidence: 90%

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

Shirazian¹,

Aina²,

Park³

et al. 2017

IJNRD

102

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Chronic kidney disease-associated pruritus (CKD-aP) is a distressing, often overlooked condition in patients with CKD and end-stage renal disease. It affects ~40% of patients with end-stage renal disease and has been associated with poor quality of life, poor sleep, depression, and mortality. Prevalence estimates vary based on the instruments used to diagnose CKD-aP, and standardized diagnostic instruments are sorely needed. Treatment studies have often yielded conflicting results. This is likely related to studies that are limited by small sample size, flawed designs, and nonstandardized diagnostic instruments. Several large well-designed treatment trials have recently been completed and may soon influence CKD-aP management.

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Comparison of Gabapentin and Ketotifen in Treatment of Uremic Pruritus in Hemodialysis Patients

Cited by 27 publications

References 17 publications

Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

Gabapentin for uremic pruritus: a systematic review of randomized controlled trials

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

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