90.Results from random effect models were consistent with fixed effect models. CONCLUSIONS: Based on this network meta-analysis, a significantly greater proportion of patients with plaque psoriasis are expected to achieve a PASI 75 or PASI 90 response when treated with infliximab 5 mg/kg than with ustekinumab 45 mg or ustekinumab 90 mg.
OBJECTIVES:A systematic review of chronic non-malignant pain treatment with tapentadol and strong opioids. METHODS: Thirteen electronic databases and other sources were searched until November 2010 for relevant RCTs in chronic moderate/ severe pain investigating at least one WHO step 3 opioid. Two separate analyses were performed, one for trials reporting the outcome in patients with severe pain, the other including both moderate and severe pain conditions. Indirect comparisons were performed based on a network analysis. Trials with an enriched or an enriched withdrawal design were excluded. Primary (pain intensity) and a number of secondary endpoints were evaluated, including pain relief (30% and 50%), patient global impression of change, quality-of-life, quality-of-sleep, discontinuations, and selected adverse events. RESULTS: Only 10 trials were eligible for analysis of patients with severe pain (8 investigating tapentadol and 2 trials comparing buprenorphine patch (TDB) vs placebo). For moderate/severe pain, 42 relevant trials were identified and indirect comparisons with TDB, transdermal fentanyl (TDF), hydromorphone, morphine, and oxymorphone were performed. Tapentadol showed statistically favourable results over oxycodone for pain intensity, 30% and 50% pain relief, patient global impression of change, and quality-of-life. Some of the most important adverse events of chronic opioid treatment were significantly less frequent with tapentadol as compared to oxycodone i.e. constipation, nausea, and vomiting; discontinuations due to these adverse events were found significantly reduced with tapentadol. Similar results were obtained for the network analysis, i.e. tapentadol was superior for the primary outcome (pain intensity) to hydromorphone and morphine, whereas fentanyl and oxymorphone showed trends in favour of these treatments. Significantly less frequent gastrointestinal adverse events were observed using tapentadol in comparison with fentanyl, hydromorphone, morphine, and oxymorphone, apparently leading to significantly reduced treatment discontinuations (for any reason). CONCLUSIONS: The benefit risk ratio of tapentadol appears to be better compared to other step 3 opioids.
PSY6 THE HEALTH IMPROVEMENT NETWORK (THIN)
