Should we prescribe anticonvulsants for acute herpes zoster neuralgia and to prevent postherpetic neuralgia? A protocol for meta-analysis and benefit-risk assessment

Abstract

Background: Herpes zoster-associated pain [i.e., acute herpes zoster neuralgia (AHN) and postherpetic neuralgia (PHN)] has the potential to cause significant patients’ burden and heath resource expenditure. PHN is refractory to the existing treatments, and the consensus is preventing the transition of AHN to PHN is better than treating PHN. Anticonvulsants (e.g., gabapentin, pregabalin) have been recommended as one of the first-line therapies for PHN. In practice, anticonvulsants have also decreased the severity and duration of AHN and reduced the incidence of PHN. Nevertheless, its clinical application to AHN is hampered by inadequate evidence for its efficacy and safety. We performed this protocol for a systematic review to explore the efficacy and safety of anticonvulsants for AHN. Besides, a benefit-risk assessment of anticonvulsants for AHN would be performed to estimate the extent to which these drugs could relieve symptoms and whether the benefits outweigh harms. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) was used to prepare our protocol and the results will be reported according to the PRISMA. We will search the China National Knowledge Infrastructure (CNKI), Chinese VIP Information (VIP), Cochrane Library, Embase, and PubMed databases, from inception to August 2019. Furthermore, Clinicaltrials (http://www.clinicaltrials.com) and Chinese Clinical Trial Registry (http://www.chictr.org.cn/abouten.aspx) will also be searched for relevant studies. Selection of eligible articles and data extraction will be independently performed by reviewers. We will record the characteristic information, pain outcomes, incidence of PHN and adverse effects. Data synthesis and other statistical analyses will be conducted using Review Manager Software 5.3 and STATA13.0. Furthermore, risk of bias assessment, meta-regression and subgroup analyses, publication bias assessment, grading of evidence will be performed for included studies. Ethics and dissemination: As this systematic review will be performed based on published data, no ethical approval is needed. The findings will be submitted in peer-reviewed journals for publication. Systematic review registration: PROSPERO CRD42019133449. Abbreviations: 95% CIs = 95% confidence intervals, AHN = acute herpetic neuralgia, CNKI = China National Knowledge Infrastructure, GRADE = Grading of Recommendations Assessment, Development and Evaluation, MDs = mean differences, NNTB = number needed to treat to benefit, NNTH = number needed to treat to harm, PHN = postherpetic neuralgia, PRISMA-P = Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, RCTs = randomized controlled trials, RD = risk difference, RoB = risk of bias, SMDs = standardized mean differences, WHO = World Health Organization.