Despite surgery options, drug therapy is most frequently used for treating trigeminal neuralgia (TN). According to results of this network meta-analysis of 8 different drugs, lidocaine, botulinum toxin type A and carbamazepine stood out for their high efficacy and should be recommended as the primary choice for clinical applications. Tizanidine, lamotrigine and oxcarbazepine were superior but pimozide and proparacaine were inferior to placebo.
Authors identified 13 studies (12 randomised controlled trials and 1 retrospective study) involving 672 patients with TN. Among the included studies, sample size ranged from 11-178 patients and follow-up period ranged from 0.75-87.72 months. Pain duration ranged from 4.25-13.2 years.
Lidocaine (OR, 17.0; 95% Credible Interval [CrI], 2.4-130.0), carbamazepine (OR, 13.0; 95% CrI, 4.2-49.0), botulinum toxin type A (OR, 14.0; 95% CrI, 3.9-56.0), and oxcarbazepine (OR, 7.7; 95% CrI, 1.1-74.0) were significantly superior to placebo. As per surface under cumulative ranking curve (SUCRA), lidocaine, botulinum toxin type A and carbamazepine were the top 3 ranked drugs among all evaluated treatments (SUCRA, 0.82; 0.81 and 0.79, respectively). Additionally, carbamazepine had more desirable performance than pimozide, proparacaine and lamotrigine.
Several meta-analyses have conducted pairwise comparisons between the above mentioned drugs. But lack of a systematical comparison makes results of each study incomplete, inconclusive and sometimes contradictory. Authors claim that their findings should supplement existing studies about TN and provide a more accurate treatment selection strategy for patients suffering from TN.