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BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2001

Open Access 01-12-2001 | Research article

Using evidence from different sources: an example using paracetamol 1000 mg plus codeine 60 mg

Authors: Lesley A Smith, R Andrew Moore, Henry J McQuay, David Gavaghan

Published in: BMC Medical Research Methodology | Issue 1/2001

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Abstract

Background

Meta-analysis usually restricts the information pooled, for instance using only randomised, double-blind, placebo-controlled trials. This neglects other types of high quality information. This review explores using different information for the combination of paracetamol 1000 mg and codeine 60 mg in acute postoperative pain.

Results

Randomised, double-blind, placebo-controlled trials of paracetamol 1000 mg and codeine 60 mg had an NNT of 2.2 (95% confidence interval 1.7 to 2.9) for at least 50% pain relief over four to six hours in three trials with 197 patients. Computer simulation of randomised trials demonstrated 92% confidence that the simulated NNT was within ± 0.5 of the underlying value of 2.2 with this number of patients. The result was supported a rational dose-response relationship for different doses of paracetamol and codeine in 17 additional trials with 1,195 patients. Three controlled trials lacking a placebo and with 117 patients treated with of paracetamol 1000 mg and codeine 60 mg had 73% (95%CI 56% to 81%) of patients with at least 50% pain relief, compared with 57% (48% to 66%) in placebo controlled trials. Six trials in acute pain were omitted because of design issues, like the use of different pain measures or multiple dosing regimens. In each paracetamol 1000 mg and codeine 60 mg was shown to be better than placebo or comparators for at least one measure.

Conclusions

Different designs of high quality trials can be used to support limited information used in meta-analysis without recourse to low quality trials that might be biased.
Appendix
Available only for authorised users
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Metadata
Title
Using evidence from different sources: an example using paracetamol 1000 mg plus codeine 60 mg
Authors
Lesley A Smith
R Andrew Moore
Henry J McQuay
David Gavaghan
Publication date
01-12-2001
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2001
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/1471-2288-1-1

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