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首页> 外文期刊>Acute pain: international journal of acute pain management >IONSYS? versus morphine PCA: Analysis of the current literature using a Bayesian approach
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IONSYS? versus morphine PCA: Analysis of the current literature using a Bayesian approach

机译：IONSYS？与吗啡五氯苯甲醚：使用贝叶斯方法分析当前文献

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Background: The IONSYS? device, providing transdermal fentanyl, has been found as non-inferior to intravenous morphine PCA in four non-inferiority studies; the accepted loss of efficacy had to be lower than a 10% decrease of therapeutic success. Bayesian analysis allows to compute likelihoods pertaining to any chosen difference in therapeutic rate of success, and is not limited to conclusions based on arbitrary thresholds. Methods: We try to show the superiority of intravenous morphine PCA, using the data of the four comparative studies. We have subjected the four studies to a Bayesian analysis, with respect to the common primary outcome reported in the four studies, in a sequence that parallels their dates of publication. In a first analysis we used an uninformative prior, and in a second analysis a moderately sceptical prior. Results: With an uninformative prior probability, there is a 75% probability that some (>0%) increased rate of success exists with morphine PCA. With a moderately sceptical prior the probability is still around 69%. The probability of a relative risk reduction of treatment failure >10% of difference, is 14.8% with an initial uninformative prior and 3.7% with a sceptical prior. The probability of a relative risk reduction >20% is virtually non-existent. Conclusions: Although, some decrease in the rate of therapeutic success can be expected, the fentanyl transdermal system seems a viable substitute to intravenous morphine PCA, as a large difference in the rate of therapeutic success is unlikely.
机译：背景：IONSYS？在四项非劣效性研究中，发现提供透皮芬太尼的装置不亚于静脉吗啡PCA。公认的功效损失必须低于治疗成功率降低10％。贝叶斯分析允许计算与治疗成功率的任何选定差异有关的可能性，并且不限于基于任意阈值的结论。方法：我们试图利用四个比较研究的数据来证明静脉吗啡PCA的优越性。对于这四项研究报告的共同主要结果，我们对这四项研究进行了贝叶斯分析，其排列顺序与它们的发表日期相符。在第一个分析中，我们使用了无信息的先验，在第二个分析中，我们使用了中度怀疑的先验。结果：在无先验信息的情况下，吗啡PCA存在75％的成功率（> 0％）增加。在具有中等怀疑性的先验下，该可能性仍然在69％左右。治疗失败的相对风险降低的可能性>差异的10％，在最初没有提供信息的先验情况下为14.8％，在有怀疑的先验情况下为3.7％。相对风险降低> 20％的可能性几乎不存在。结论：尽管可以预期治疗成功率会有所下降，但芬太尼透皮系统似乎可以替代静脉吗啡PCA，因为治疗成功率差异不大。

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