Cochrane · systematic review · CD008320
Pharmacological interventions for pruritus in adult palliative care patients
Boehlke, C, Joos, L, Coune, B, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
61
current version
GRADE rated
22
No studies
38
Included studies
NR
No studies 38 · 62.3%Ungraded 1 · 1.6%Very low 8 · 13.1%Low 12 · 19.7%Moderate 1 · 1.6%High 1 · 1.6%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings table ‐ GABA‐analogues versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: health problem or population
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ GABA‐analogues vs placebo | no estimate extracted | 5 studies · 297 participants | Moderate Downgraded: imprecision |
Quality of life ‐ not measured Summary of findings table ‐ GABA‐analogues vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ GABA‐analogues vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not reported Summary of findings table ‐ GABA‐analogues vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ GABA‐analogues vs placebo | RR 2.63 [0.76, 9.05] | 1 study · 15 participants | Low Downgraded: imprecision |
Summary of findings table ‐ Gabapentin versus pregabalin for patients with chronic kidney disease (CKD)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Gabapentin vs pregabalin | no estimate extracted | 2 studies · 100 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported Summary of findings table ‐ Gabapentin vs pregabalin | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not reported Summary of findings table ‐ Gabapentin vs pregabalin | no estimate extracted | NR | No studies |
Depression ‐ not reported Summary of findings table ‐ Gabapentin vs pregabalin | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ Gabapentin vs pregabalin | RR 4.7 [0.21, 104.14] | 2 studies · 122 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Summary of findings table ‐ Kappa‐opioid agonists versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Kappa‐opioid agonists vs placebo | no estimate extracted | 6 studies · 1292 participants | High |
Quality of life ‐ not measured Summary of findings table ‐ Kappa‐opioid agonists vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Kappa‐opioid agonists vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Kappa‐opioid agonists vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse drug reaction (ADR) per patient Summary of findings table ‐ Kappa‐opioid agonists vs placebo | RR 1.73 [1.2, 2.48] | 5 studies · 1344 participants | Low Downgraded: imprecision, inconsistency |
Summary of findings table ‐ Ondansetron versus placebo for patients with chronic kidney disease (CKD) and cholestatic (CP)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Ondansetron vs placebo | no estimate extracted | 4 studies · 202 participants | Low Downgraded: imprecision, inconsistency |
Quality of life ‐ not measured Summary of findings table ‐ Ondansetron vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Ondansetron vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Ondansetron vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ Ondansetron vs placebo | RR 2.54 [0.38, 16.78] | 3 studies · 174 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings table ‐ Montelukast versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Montelukast vs placebo | no estimate extracted | 2 studies · 87 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life ‐ not measured Summary of findings table ‐ Montelukast vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Montelukast vs placebo | no estimate extracted | NR | No studies |
depression ‐ not measured Summary of findings table ‐ Montelukast vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant ‐ not measured Summary of findings table ‐ Montelukast vs placebo | no estimate extracted | NR | No studies |
Summary of findings table ‐ Fish‐oil/omega‐3 fatty acids versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prurits Summary of findings table ‐ Fish‐oil/omega‐3 fatty acids vs placebo | no estimate extracted | 4 studies · 212 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not measured Summary of findings table ‐ Fish‐oil/omega‐3 fatty acids vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Fish‐oil/omega‐3 fatty acids vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Fish‐oil/omega‐3 fatty acids vs placebo | no estimate extracted | NR | No studies |
Adverse events ‐ not measured Summary of findings table ‐ Fish‐oil/omega‐3 fatty acids vs placebo | no estimate extracted | NR | No studies |
Summary of findings table ‐ Zinc sulphate versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Zinc sulphate vs placebo | no estimate extracted | 2 studies · 76 participants | Low Downgraded: imprecision |
Quality of life ‐ not measured Summary of findings table ‐ Zinc sulphate vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Zinc sulphate vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Zinc sulphate vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Summary of findings table ‐ Zinc sulphate vs placebo | no estimate extracted | 2 studies · 160 participants | Ungraded |
Summary of findings table ‐ Cromolyn sodium versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Cromolyn sodium vs placebo | no estimate extracted | 2 studies · 100 participants | Very low Downgraded: imprecision, inconsistency |
Quality of life ‐ not measured Summary of findings table ‐ Cromolyn sodium vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Cromolyn sodium vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Cromolyn sodium vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ Cromolyn sodium vs placebo | RR 1.28 [0.02, 106.52] | 2 studies · 122 participants | Very low Downgraded: imprecision, inconsistency |
Summary of findings table ‐ Topical capsaicin versus placebo for patients with chronic kidney disease (CKD)‐associated pruritus
Population: patients with chronic kidney disease (CKD) pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Topical capsaicin vs placebo | no estimate extracted | 2 studies · 112 participants | Low Downgraded: imprecision |
Quality of life ‐ not measured Summary of findings table ‐ Topical capsaicin vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Topical capsaicin vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Topical capsaicin vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ Topical capsaicin vs placebo | RR 3.69 [1.17, 11.67] | 3 studies · 116 participants | Low Downgraded: imprecision |
Summary of findings table ‐ Naltrexone versus placebo for patients with cholestatic pruritus (CP)
Population: patients with cholestatic pruritus (CP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
PruritusScale from: 0 to 10 Summary of findings table ‐ Naltrexone vs placebo | no estimate extracted | 2 studies · 52 participants | Low Downgraded: imprecision, inconsistency |
Quality of life ‐ not measured Summary of findings table ‐ Naltrexone vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Naltrexone vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Naltrexone vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ Naltrexone vs placebo | RR 2.67 [1.32, 5.39] | 1 study · 40 participants | Low Downgraded: imprecision |
Summary of findings table ‐ Rifampin/rifampicin versus placebo for patients with cholestatic pruritus (CP)
Population: patients with cholestatic pruritus (CP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Summary of findings table ‐ Rifampin/rifampicin vs placebo | no estimate extracted | 2 studies · 42 participants | Very low Downgraded: imprecision, inconsistency |
Quality of life ‐ not measured Summary of findings table ‐ Rifampin/rifampicin vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Summary of findings table ‐ Rifampin/rifampicin vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Rifampin/rifampicin vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Summary of findings table ‐ Rifampin/rifampicin vs placebo | RR 0.29 [0.03, 2.51] | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings table ‐ Flumecinol versus placebo for patients with cholestatic pruritus (CP)
Population: patients with cholestatic pruritus (CP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus: significant improvement Summary of findings table ‐ Flumecinol vs placebo | RR 2.32 [0.54, 10.1] | 2 studies · 69 participants | Very low Downgraded: imprecision, inconsistency |
Pruritus Summary of findings table ‐ Flumecinol vs placebo | no estimate extracted | 1 study · 50 participants | Low Downgraded: imprecision |
Quality of life Summary of findings table ‐ Flumecinol vs placebo | no estimate extracted | 1 study · 50 participants | Low Downgraded: imprecision |
Patient satisfaction ‐ not measured Summary of findings table ‐ Flumecinol vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Summary of findings table ‐ Flumecinol vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient ‐ not measured Summary of findings table ‐ Flumecinol vs placebo | no estimate extracted | NR | No studies |
Paroxetine versus placebo for pruritus
Population: palliative care patients with pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Paroxetine vs placebo | no estimate extracted | 1 study · 48 participants | Moderate Downgraded: imprecision |
Quality of life ‐ not measured Paroxetine vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction Paroxetine vs placebo | no estimate extracted | 1 study · 48 participants | Low Downgraded: risk of bias, imprecision |
Depression ‐ not measured Paroxetine vs placebo | no estimate extracted | NR | No studies |
Nausea Paroxetine vs placebo | no estimate extracted | 1 study · 52 participants | Moderate Downgraded: imprecision |
Vomiting Paroxetine vs placebo | no estimate extracted | 1 study · 52 participants | Moderate Downgraded: imprecision |
Sleepiness Paroxetine vs placebo | no estimate extracted | 1 study · 52 participants | Moderate Downgraded: imprecision |
Naltrexone versus placebo for pruritus
Population: participants with cholestatic pruritus (CP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Naltrexone vs placebo | no estimate extracted | 2 studies · 52 participants | Moderate Downgraded: inconsistency |
Quality of life ‐ not measured Naltrexone vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Naltrexone vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Naltrexone vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Naltrexone vs placebo | RR 4.07 [2.07, 8] | 3 studies · 116 participants | Moderate Downgraded: imprecision |
Nalfurafine versus placebo for pruritus
Population: participants with uraemic pruritus (UP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Nalfurafine vs placebo | no estimate extracted | 3 studies · 422 participants | Moderate Downgraded: risk of bias |
Quality of life ‐ not measured Nalfurafine vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Nalfurafine vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Nalfurafine vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse drug reaction (ADR) per participant Nalfurafine vs placebo | RR 1.62 [1.15, 2.29] | 3 studies · 422 participants | Moderate Downgraded: imprecision |
Ondansetron versus placebo for pruritus
Population: patients with uraemic pruritus (UP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Ondansetron vs placebo | no estimate extracted | 2 studies · 151 participants | Moderate Downgraded: risk of bias |
Quality of life ‐ not measured Ondansetron vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Ondansetron vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Ondansetron vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per patient Ondansetron vs placebo | RR 7.53 [0.97, 58.51] | 2 studies · 155 participants | Very low Downgraded: risk of bias, imprecision |
Gabapentin versus placebo for pruritus
Population: patients with uraemic pruritus (UP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Gabapentin vs placebo | no estimate extracted | 2 studies · 118 participants | Moderate Downgraded: risk of bias |
Quality of life ‐ not measured Gabapentin vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Gabapentin vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not reported Gabapentin vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Gabapentin vs placebo | RR 2.63 [0.76, 9.05] | 1 study · 15 participants | Low Downgraded: imprecision |
Rifampicin versus placebo for pruritus
Population: participants with cholestatic pruritus (CP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Rifampicin vs placebo | no estimate extracted | 2 studies · 42 participants | Low Downgraded: inconsistency |
Quality of life ‐ not measured Rifampicin vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Rifampicin vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Rifampicin vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Rifampicin vs placebo | RR 0.29 [0.03, 2.51] | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Flumecinol versus placebo for pruritus
Population: participants with cholestatic pruritus (CP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus: significant improvement Flumecinol vs placebo | RR 1.89 [1.05, 3.39] | 2 studies · 69 participants | Low Downgraded: imprecision, inconsistency |
Pruritus Flumecinol vs placebo | no estimate extracted | 1 study · 50 participants | Low Downgraded: imprecision |
Quality of life Flumecinol vs placebo | no estimate extracted | 1 study · 50 participants | Moderate Downgraded: imprecision |
Patient satisfaction ‐ not measured Flumecinol vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Flumecinol vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant ‐ not reported Flumecinol vs placebo | no estimate extracted | 2 studies · 69 participants | Ungraded |
Cromolyn sodium versus placebo for pruritus
Population: participants with uraemic pruritus (UP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Cromolyn sodium vs placebo | no estimate extracted | 2 studies · 100 participants | Moderate Downgraded: inconsistency |
Quality of life ‐ not measured Cromolyn sodium vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Cromolyn sodium vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Cromolyn sodium vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Cromolyn sodium vs placebo | RR 1.12 [0.4, 3.08] | 2 studies · 122 participants | Very low Downgraded: imprecision, inconsistency |
Topical capsaicin versus vehicle for pruritus
Population: participants with uraemic pruritus (UP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Topical capsaicin vs vehicle | no estimate extracted | 2 studies · 112 participants | Moderate Downgraded: imprecision |
Quality of life ‐ not measured Topical capsaicin vs vehicle | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Topical capsaicin vs vehicle | no estimate extracted | NR | No studies |
Depression ‐ not measured Topical capsaicin vs vehicle | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Topical capsaicin vs vehicle | RR 4.64 [2.05, 10.51] | 3 studies · 116 participants | Moderate Downgraded: imprecision |
Zinc sulphate versus placebo for pruritus
Population: patients with uraemic pruritus (UP)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pruritus Zinc sulphate vs placebo | no estimate extracted | 2 studies · 76 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not measured Zinc sulphate vs placebo | no estimate extracted | NR | No studies |
Patient satisfaction ‐ not measured Zinc sulphate vs placebo | no estimate extracted | NR | No studies |
Depression ‐ not measured Zinc sulphate vs placebo | no estimate extracted | NR | No studies |
Risk for at least one adverse event per participant Zinc sulphate vs placebo | no estimate extracted | 2 studies · 160 participants | Ungraded |
Comparison
Population: participants with CKD‐associated or cholestatic pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Naltrexone versus placebo (pruritus in participants with CKDP/UP and CP)* | no estimate extracted | NR | Moderate |
Naltrexone versus placebo (pruritus in participants with CKDP/UP) | no estimate extracted | NR | Moderate |
Naltrexone versus placebo (pruritus in participants with CP) | no estimate extracted | NR | Moderate |
Comparison
Population: participants with CKD‐associated pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nalfurafine versus placebo (pruritus in participants with CKDP/UP) | no estimate extracted | NR | Moderate |
Comparison
Population: participants with CKD‐associated or cholestatic pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ondansetron versus placebo (pruritus in participants with CKDP/UP and CP) | no estimate extracted | NR | Moderate |
Ondansetron versus placebo (pruritus in participants with CKDP/UP) | no estimate extracted | NR | Moderate |
Ondansetron versus cyproheptadine (pruritus in participants with CKDP) | no estimate extracted | NR | Moderate |
Ondansetron versus placebo (pruritus in participants with CP) | no estimate extracted | NR | Moderate |
Comparison
Population: participants with CKD‐associated pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gabapenten versus placebo (pruritus in participants with CKDP/UP) | no estimate extracted | NR | Moderate |
Comparison
Population: participants with cholestatic pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rifampin/rifampicin versus placebo (pruritus in participants with CKDP/UP) | no estimate extracted | NR | Moderate |
Comparison
Population: participants with CKD‐associated pruritus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Capsaicin versus placebo (pruritus in Participnats with CKDP/UP) | no estimate extracted | NR | Moderate |
Comparison
Population: palliative care patients with advanced diseases
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Paroxetine versus placebo (patient satisfaction in palliative care patients) | no estimate extracted | NR | Moderate |