Yang F, Lin Q, Dong L, et al. Efficacy of 8 Different Drug Treatments for Patients With Trigeminal Neuralgia: A Network Meta-analysis. Clin J Pain. 2018 Jul;34(7):685-690. doi: 10.1097/AJP.0000000000000577.
Discipline Area Score
Physician 6 / 7

OBJECTIVES: Trigeminal neuralgia (TN) is commonly seen in older persons and negatively influences their daily life. Although some research on the efficacy of TN drugs has been conducted, the optimal choice still remains uncertain. Therefore, this network meta-analysis (NMA) evaluated the efficacy and performance of 8 drugs with respect to TN.

METHODS: All literature was retrieved from the PubMed and Embase electronic databases by jointly searching key terms. The only outcome was response rate, expressed as the odds ratio with 95% credible/confidence intervals. Both a pairwise meta-analysis and NMA were conducted. Heat plot and node splitting were computed to measure the consistency between direct and indirect evidence. In addition, surface under cumulative ranking curves were utilized to rank different drugs for treating TN.

RESULTS: In total, 13 studies and 672 TN patients were included in this NMA. With regard to the primary endpoint response rate, only lidocaine (LDC), botulinum toxin type A (BTX-A), and carbamazepine (CBZ) had a statistical better performance than the placebo. According to the surface under cumulative ranking curves, LDC, BTX-A, and CBZ are the most effective drugs for treating patients with TN.

CONCLUSIONS: Among the 8 drugs investigated, all exhibited a capacity to alleviate TN more than the placebo except for pimozide and proparacaine. Moreover, LDC, BTX-A, and CBZ stood out for their high efficacy and could be recommended as the primary choice of treatment for TN.

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Comments from MORE raters

Physician rater

Great information to have for a difficult problem.

Physician rater

A well done study. Unfortunately, there is no oral route for lidocaine.

Physician rater

Not sure that I completely buy that one study (24 patients) makes lidocaine a first-line treatment.

Physician rater

This certainly confirms the overall clinical impression that most neurologists seem to have: CBZ is first-line (still, after all these years) but OXC can replace it. LDC seems impractical as a long-term therapy, although it could be useful for acute breakthrough when already on another therapy. I was unaware that BTX was being used for this condition. The other treatments are worth trying, but of less well established efficacy.

Physician rater

This is a well done review article on the treatment of trigeminal neuralgia. It ranked the treatments in value with lidocaine solution in the mouth as most effective (moniter dose to avoid toxicity), botulina toxin next (but costly), and then carbamazine. The other treatments were not statistically useful.
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