Efficacy of Cetirizine and Gabapentin in the management of Postburn Pruritus – A Systematic Review and Meta-analysis

Abstract

Background: Pruritus is a common and debilitating complication of burn wound healing and rehabilitation, and although it appears to be related to the release of histamine, is poorly responsive to conventional H1-antihistamines, likely because of underlying neuropathic mechanisms. Gabapentin may be a new possibility, and is less well documented.

Objective: To synthesize and evaluate the comparative effectiveness and safety of gabapentin versus cetirizine in the management of postburn pruritus.

Methods: The systematic review and meta-analysis (SRMA) will be carried out according to the guidelines of PRISMA 2020 and Cochrane Handbook. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar were used to perform electronic database search for both language and date restrictions. Randomized controlled trials (RCTs) were selected that compared oral gabapentin with the antihistamine cetirizine for postburn use. The risk ratios (RR) for dichotomous itch remission outcomes and the mean difference (MD) for continuous post-treatment Visual Analogue Scale (VAS) scores were computed by pooling using the Review Manager (RevMan 5.4) software with random-effects models.

Results: Four RCTs with 287 participants were included. In pooled analysis, gabapentin was significantly more effective and more effective in improving itch remission rates than cetirizine (RR 0.46; 95% CI: 0.28–0.78; p=0.004). The post-treatment VAS scores for continuous pooling showed significant heterogeneity (I^2=71% to 92%) and were significantly lower for gabapentin (MD -1.56; 95% CI: -2.79 to -0.32; p=0.01). Gabapentin was more effective than placebo at reducing itch and at providing secondary sleep benefits, but was associated with an increased incidence of transient central nervous system side-effects like drowsiness, dizziness, and sedation. Conclusion: Gabapentin is more effective than cetirizine in achieving postburn pruritus severity reduction and remission for postburn pruritus, and should be used with caution because of its sedative effects.