Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Systematic Review Article

An Overview of the Methodologies and the Quality of Studies on Pharmacotherapy for the Treatment of Fibromyalgia

Author(s): Renata Ferraz Figueiredo, Alana Teles Costa, Rafaella de Oliveira Santos Silva, Tatiana Damasceno da Silva, Thaciana dos Santos Alcântara, Divaldo Pereira de Lyra Junior and Cristiani Isabel Banderó Walker*

Volume 18, Issue 4, 2022

Published on: 13 May, 2022

Page: [305 - 316] Pages: 12

DOI: 10.2174/1573397118666220318105002

Price: $65

conference banner
Abstract

Background: It is often unclear whether systematic reviews and primary studies are de-signed to elucidate the efficacy or effectiveness of interventions. This may compromise the use of the information in clinical or policy decisions.

Objective: This overview aimed to evaluate the methodological profiles of studies on fibromyalgia pharmacotherapy in terms of the quality and nature of the interventions (efficacy versus effective-ness).

Methods: The protocol was registered in the International Prospective Register of Systematic Re-views database. Seven databases were searched for relevant publications. Systematic reviews inves-tigating the effectiveness or efficacy of fibromyalgia pharmacotherapy were included. Methodolog-ical quality was investigated using A MeaSurement Tool to Assess Systematic Reviews (AM-STAR), and efficacy andeffectiveness were evaluated using Rating of Included Trials on the Effica-cy-effectiveness Spectrum (RITES).

Results: In this overview, 4,107 studies were initially identified. 8 systematic reviews and 34 prima-ry studies remained after overlaps were removed. Of the eight systematic reviews, 4.76% (n=3) and 7.93% (n=5) were of moderate and high quality, respectively. An analysis of systematic reviews clearly showed the criteria “participants characteristics” and “trial setting" with the most frequent answers as scales 1 and 2 (strong emphasis on efficacy or rather strong emphasis on efficacy), re-spectively. RITES analysis revealed that the most frequent response was “strong emphasis on effi-cacy” in 68% (92/136) of primary studies.

Conclusion: This analysis showed, in both systematic reviews and primary studies, a predominantly strong emphasis on efficacy, suggesting the need for methodological quality improvement in future studies, especially those designed to provide evidence related to effectiveness. The protocol for this overview has been registered in the International Prospective Register of Sys-tematic Reviews (PROSPERO; CRD42018095943).

Keywords: Fibromyalgia, pharmacotherapy, efficacy, effectiveness, systematic review, qualitative evaluations.

« Previous Next »
Graphical Abstract

[1]
Farhad K. Current diagnosis and treatment of painful small fiber neuropathy. Curr Neurol Neurosci Rep 2019; 19(12): 103.
[http://dx.doi.org/10.1007/s11910-019-1020-1] [PMID: 31773305]
[2]
Häuser W, Perrot S, Clauw DJ, Fitzcharles MA. Unravelling fibromyalgia-steps toward individualized management. J Pain 2018; 19(2): 125-34.
[http://dx.doi.org/10.1016/j.jpain.2017.08.009] [PMID: 28943233]
[3]
Simister HD, Tkachuk GA, Shay BL, Vincent N, Pear JJ, Skrabek RQ. Randomized controlled trial of online acceptance and commitment therapy for fibromyalgia. J Pain 2018; 19(7): 741-53.
[http://dx.doi.org/10.1016/j.jpain.2018.02.004] [PMID: 29481976]
[4]
Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int 2017; 37(9): 1527-39.
[http://dx.doi.org/10.1007/s00296-017-3725-2] [PMID: 28447207]
[5]
Marques AP, Santo ASE, Berssaneti AA, Matsutani LA, Yuan SLK. A prevalência de fibromialgia: Atualização da revisão de literatura. Rev Bras Reumatol 2017; 57(4): 356-63.
[http://dx.doi.org/10.1016/j.rbr.2016.10.004]
[6]
Martinez JE, Paiva ES, Rezende MC, et al. EpiFibro (Brazilian Fibromyalgia Registry): Data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation. Rev Bras Reumatol Engl Ed 2017; 57(2): 129-33.
[http://dx.doi.org/10.1016/j.rbre.2016.09.012] [PMID: 28343617]
[7]
Bazzichi L, Giacomelli C, Consensi A, et al. One year in review 2020: fibromyalgia. Clin Exp Rheumatol 2020; 38(1) (Suppl. 123): 3-8.
[PMID: 32116216]
[8]
Häuser W, Sarzi-Puttini P, Fitzcharles MA. Fibromyalgia syndrome: Under, over and misdiagnosis. Clin Exp Rheumatol 2019; 37(1) (Suppl. 116): 90-7.
[PMID: 30747096]
[9]
Krasselt M, Baerwald C. Fibromyalgia: Current recommendations for diagnosis and therapy. Dtsch Med Wochenschr 2018; 143(15): 1103-8.
[http://dx.doi.org/10.1055/a-0542-9531] [PMID: 30060282]
[10]
Heymann RE, Paiva ES, Martinez JE, et al. New Guidelines for the diagnosis of fibromyalgia. Rev Bras Reumatol 2017; 57(S2): 467-76.
[http://dx.doi.org/10.1016/j.rbr.2017.05.006]
[11]
Lawson K. Potential drug therapies for the treatment of fibromyalgia. Expert Opin Investig Drugs 2016; 25(9): 1071-81.
[http://dx.doi.org/10.1080/13543784.2016.1197906] [PMID: 27269389]
[12]
Andrews P, Paul L, Steultjens M. Non pharmacological management of fibromyalgia: A systematic review of systematic reviews. Ann Rheumat Dis 2019; 78: 1050.
[http://dx.doi.org/10.1136/annrheumdis-2019-eular.5419]
[13]
Fritz JM, Cleland J. Effectiveness versus efficacy: More than a debate over language. J Orthop Sports Phys Ther 2003; 33(4): 163-5.
[http://dx.doi.org/10.2519/jospt.2003.33.4.163] [PMID: 12723672]
[14]
Gartlehner G, Hansen RA, Nissman D, Lohr KN, Carey TS. Criteria for distinguishing effectiveness from efficacy trials in systematic reviews. AHRQ Technical Reviews 2006; 12: 1-28.
[PMID: 20734508]
[15]
Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358: j4008.
[http://dx.doi.org/10.1136/bmj.j4008] [PMID: 28935701]
[16]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6(7): e1000097.
[http://dx.doi.org/10.1371/journal.pmed.1000097] [PMID: 19621072]
[17]
Wieland LS, Berman BM, Altman DG, et al. Rating of included trials on the efficacy-effectiveness spectrum: Development of a new tool for systematic reviews. J Clin Epidemiol 2017; 84: 95-104.
[http://dx.doi.org/10.1016/j.jclinepi.2017.01.010] [PMID: 28188898]
[18]
Lorenz RC, Matthias K, Pieper D, et al. A psychometric study found AMSTAR 2 to be a valid and moderately reliable appraisal tool. J Clin Epidemiol 2019; 114: 133-40.
[http://dx.doi.org/10.1016/j.jclinepi.2019.05.028] [PMID: 31152864]
[19]
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5(1): 210.
[http://dx.doi.org/10.1186/s13643-016-0384-4] [PMID: 27919275]
[20]
Kim SY. Efficacy versus effectiveness. Korean J Fam Med 2013; 34(4): 227.
[http://dx.doi.org/10.4082/kjfm.2013.34.4.227] [PMID: 23904951]
[21]
Hosmer DW, Lemeshow S. Applied logistic regression. (2nd ed.). New York: John Wiley & Sons, Inc. 2000; pp. 118-28.
[http://dx.doi.org/10.1002/0471722146]
[22]
Cording M, Derry S, Phillips T, Moore RA, Wiffen PJ. Milnacipran for pain in fibromyalgia in adults. Cochrane Database Syst Rev 2015; 2015(10): CD008244.
[http://dx.doi.org/10.1002/14651858.CD008244.pub3] [PMID: 26482422]
[23]
Derry S, Gill D, Phillips T, Moore RA. Milnacipran for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012; 3(3): CD008244.
[PMID: 22419330]
[24]
Häuser W, Urrútia G, Tort S, Uçeyler N, Walitt B. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database Syst Rev 2013; (1): CD010292.
[http://dx.doi.org/10.1002/14651858.CD010292] [PMID: 23440848]
[25]
Hearn L, Derry S, Moore RA. Lacosamide for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012; 2012(2): CD009318.
[http://dx.doi.org/10.1002/14651858.CD009318.pub2] [PMID: 22336864]
[26]
Stockings E, Campbell G, Hall WD, et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: A systematic review and meta-analysis of controlled and observational studies. Pain 2018; 159(10): 1932-54.
[http://dx.doi.org/10.1097/j.pain.0000000000001293] [PMID: 29847469]
[27]
Tort S, Urrútia G, Nishishinya MB, Walitt B. Monoamine oxidase inhibitors (MAOIs) for fibromyalgia syndrome. Cochrane Database Syst Rev 2012; 26(4): CD009807.
[http://dx.doi.org/10.1002/14651858.CD009807] [PMID: 22513976]
[28]
Üçeyler N, Sommer C, Walitt B, Häuser W. Anticonvulsants for fibromyalgia. Cochrane Database Syst Rev 2013; 2017(10): CD010782.
[PMID: 24129853]
[29]
Welsch P, Bernardy K, Derry S, Moore RA, Häuser W. Mirtazapine for fibromyalgia in adults. Cochrane Database Syst Rev 2018; 8(8): CD012708.
[PMID: 30080242]
[30]
Ginsberg F, Joos E, Geczy J, Brahwyler J, Vandekerckhove K, Famaey JP. A pilot randomized placebo-controlled study of pirlindole in the treatment of primary fibromyalgia. J Musculoskeletal Pain 1998; 6(2): 5-17.
[http://dx.doi.org/10.1300/J094v06n02_02]
[31]
Arnold LM, Clauw D, Wang F, Ahl J, Gaynor PJ, Wohlreich MM. Flexible dosed duloxetine in the treatment of fibromyalgia: A randomized, double-blind, placebo-controlled trial. J Rheumatol 2010; 37(12): 2578-86.
[http://dx.doi.org/10.3899/jrheum.100365] [PMID: 20843911]
[32]
Arnold LM, Gendreau RM, Palmer RH, Gendreau JF, Wang Y. Efficacy and safety of milnacipran 100 mg/day in patients with fibromyalgia: Results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2010; 62(9): 2745-56.
[http://dx.doi.org/10.1002/art.27559] [PMID: 20496365]
[33]
Chappell AS, Bradley LA, Wiltse C, Detke MJ, D’Souza DN, Spaeth M. A six-month double-blind, placebo-controlled, randomized clinical trial of duloxetine for the treatment of fibromyalgia. Int J Gen Med 2008; 1: 91-102.
[http://dx.doi.org/10.2147/IJGM.S3979] [PMID: 20428412]
[34]
Clauw DJ, Mease P, Palmer RH, Gendreau RM, Wang Y. Milnacipran for the treatment of fibromyalgia in adults: A 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clinical trial. Clin Ther 2008; 30(11): 1988-2004.
[http://dx.doi.org/10.1016/j.clinthera.2008.11.009] [PMID: 19108787]
[35]
Clauw DJ, Mease PJ, Palmer RH, Trugman JM, Wang Y. Continuing efficacy of milnacipran following long-term treatment in fibromyalgia: A randomized trial. Arthritis Res Ther 2013; 15(4): R88.
[http://dx.doi.org/10.1186/ar4268] [PMID: 23953493]
[36]
Crofford LJ, Rowbotham MC, Mease PJ, et al. Pregabalin for the treatment of fibromyalgia syndrome: Results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2005; 52(4): 1264-73.
[http://dx.doi.org/10.1002/art.20983] [PMID: 15818684]
[37]
Fiz J, Durán M, Capellà D, Carbonell J, Farré M. Cannabis use in patients with fibromyalgia: Effect on symptoms relief and health-related quality of life. PLoS One 2011; 6(4): e18440.
[http://dx.doi.org/10.1371/journal.pone.0018440] [PMID: 21533029]
[38]
Gendreau RM, Thorn MD, Gendreau JF, et al. Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol 2005; 32(10): 1975-85.
[PMID: 16206355]
[39]
Gordon DKo, Bober SL, Mindra S, Moreau JM. Medical cannabis ‒ the Canadian perspective. J Pain Res 2016; 9: 735-44.
[40]
Hannonen P, Malminiemi K, Yli-Kerttula U, Isomeri R, Roponen P. A randomized, double-blind, placebo-controlled study of moclobemide and amitriptyline in the treatment of fibromyalgia in females without psychiatric disorder. Br J Rheumatol 1998; 37(12): 1279-86.
[http://dx.doi.org/10.1093/rheumatology/37.12.1279] [PMID: 9973149]
[41]
Mease PJ, Clauw DJ, Gendreau RM, et al. The efficacy and safety of milnacipran for treatment of fibromyalgia. A randomized, double-blind, placebo-controlled trial. J Rheumatol 2009; 36(2): 398-409.
[http://dx.doi.org/10.3899/jrheum.080734] [PMID: 19132781]
[42]
Mease PJ, Clauw DJ, Trugman JM, Palmer RH, Wang Y. Efficacy of long-term milnacipran treatment in patients meeting different thresholds of clinically relevant pain relief: Subgroup analysis of a randomized, double-blind, placebo-controlled withdrawal study. J Pain Res 2014; 7: 679-87.
[http://dx.doi.org/10.2147/JPR.S70200] [PMID: 25473309]
[43]
Arnold LM, Goldenberg DL, Stanford SB, et al. Gabapentin in the treatment of fibromyalgia: A randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum 2007; 56(4): 1336-44.
[http://dx.doi.org/10.1002/art.22457] [PMID: 17393438]
[44]
Miki K, Murakami M, Oka H, Onozawa K, Yoshida S, Osada K. Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: A randomized, double-blind, placebo-controlled phase IIa study in Japan. Pain 2016; 157(9): 2089-96.
[http://dx.doi.org/10.1097/j.pain.0000000000000622] [PMID: 27218868]
[45]
Ohta H, Oka H, Usui C, Ohkura M, Suzuki M, Nishioka K. A randomized, double-blind, multicenter, placebo-controlled phase III trial to evaluate the efficacy and safety of pregabalin in Japanese patients with fibromyalgia. Arthritis Res Ther 2012; 14(5): R217.
[http://dx.doi.org/10.1186/ar4056] [PMID: 23062189]
[46]
Pauer L, Winkelmann A, Arsenault P, et al. An international, randomized, double-blind, placebo-controlled, phase III trial of pregabalin monotherapy in treatment of patients with fibromyalgia. J Rheumatol 2011; 38(12): 2643-52.
[http://dx.doi.org/10.3899/jrheum.110569] [PMID: 21965636]
[47]
Russell JI, Mease PJ, Smith TR, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 2008; 136(3): 432-44.
[http://dx.doi.org/10.1016/j.pain.2008.02.024] [PMID: 18395345]
[48]
Saxe PA, Arnold LM, Palmer RH, Gendreau RM, Chen W. Short-term (2-week) effects of discontinuing milnacipran in patients with fibromyalgia. Curr Med Res Opin 2012; 28(5): 815-21.
[http://dx.doi.org/10.1185/03007995.2012.677418] [PMID: 22429066]
[49]
Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr Med Res Opin 2006; 22(7): 1269-76.
[http://dx.doi.org/10.1185/030079906X112651] [PMID: 16834825]
[50]
Skrabek RQ, Galimova L, Ethans K, Perry D. Nabilone for the treatment of pain in fibromyalgia. J Pain 2008; 9(2): 164-73.
[http://dx.doi.org/10.1016/j.jpain.2007.09.002] [PMID: 17974490]
[51]
Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG. A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia. Hum Psychopharmacol 2004; 19 (Suppl. 1): S27-35.
[http://dx.doi.org/10.1002/hup.622] [PMID: 15378666]
[52]
Weber J, Schley M, Casutt M, et al. Tetrahydrocannabinol (Delta 9-THC) treatment in chronic central neuropathic pain and fibromyalgia patients: Results of a multicenter survey. Anesthesiol Res Pract 2009; 2009: 1-9.
[http://dx.doi.org/10.1155/2009/827290] [PMID: 20798872]
[53]
Yeephu S, Suthisisang C, Suttiruksa S, Prateepavanich P, Limampai P, Russell IJ. Efficacy and safety of mirtazapine in fibromyalgia syndrome patients: A randomized placebo-controlled pilot study. Ann Pharmacother 2013; 47(7-8): 921-32.
[http://dx.doi.org/10.1345/aph.1R725] [PMID: 23737510]
[54]
Arnold LM, Lu Y, Crofford LJ, et al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004; 50(9): 2974-84.
[http://dx.doi.org/10.1002/art.20485] [PMID: 15457467]
[55]
Arnold LM, Palmer RH, Gendreau RM, Chen W. Relationships among pain, depressed mood, and global status in fibromyalgia patients: Post hoc analyses of a randomized, placebo-controlled trial of milnacipran. Psychosomatics 2012; 53(4): 371-9.
[http://dx.doi.org/10.1016/j.psym.2012.02.005] [PMID: 22677218]
[56]
Arnold LM, Rosen A, Pritchett YL, et al. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain 2005; 119(1-3): 5-15.
[http://dx.doi.org/10.1016/j.pain.2005.06.031] [PMID: 16298061]
[57]
Arnold LM, Russell IJ, Diri EW, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain 2008; 9(9): 792-805.
[http://dx.doi.org/10.1016/j.jpain.2008.03.013] [PMID: 18524684]
[58]
Bateman L, Palmer RH, Trugman JM, Lin Y. Results of switching to milnacipran in fibromyalgia patients with an inadequate response to duloxetine: A phase IV pilot study. J Pain Res 2013; 6: 311-8.
[http://dx.doi.org/10.2147/JPR.S43395] [PMID: 23658494]
[59]
Branco JC, Cherin P, Montagne A, Bouroubi A. Longterm therapeutic response to milnacipran treatment for fibromyalgia. A European 1-year extension study following a 3-month study. J Rheumatol 2011; 38(7): 1403-12.
[http://dx.doi.org/10.3899/jrheum.101025] [PMID: 21459941]
[60]
Branco JC, Zachrisson O, Perrot S, Mainguy Y. A European multicenter randomized double-blind placebo-controlled monotherapy clinical trial of milnacipran in treatment of fibromyalgia. J Rheumatol 2010; 37(4): 851-9.
[http://dx.doi.org/10.3899/jrheum.090884] [PMID: 20156949]
[61]
Gerardi MC, Batticciotto A, Talotta R, Dito MC, Atzeni F, Sarzi-Puttini P. Efficacy of cannabis flos in patients with fibromyalgia: A monocentric observational study. Arthritis Rheumatol 2016; 68(Suppl 10) Abs. 53.
[62]
Assessing efficacy and safety of lacosamide compared to placebo in reducing signs and symptoms of fibromyalgia syndrome. NCT 00401830 2018. Available from: linicaltrials.gov/ct2/show/results/NCT00401830?term=NCT00401830&rank=1
[63]
A double-blind, placebo-controlled phase II study of Org 3770 (mirtazapine) in patients with fibromyalgia. 2012. Available from: clinical-trials.jp/user/showCteDetailE.jsp?japicId=JapicCTI-101176
[64]
Liu W, Shi L, Sawhney M, Gu X, Chen Y. Evidence for the effectiveness of anti-hypertensive medicines included on the Chinese National Reimbursement Drug List. BMC Health Serv Res 2019; 19(1): 112.
[http://dx.doi.org/10.1186/s12913-019-3937-0] [PMID: 30744609]
[65]
Raza A, Kale S, Bulent B, et al. Methodological quality assessment of meta-analyses and systematic reviews of rectal indomethacin in the prophylaxis of post-ERCP pancreatitis using AMSTAR 2. Am J Gastroenterol 2018; 113: S56.
[http://dx.doi.org/10.14309/00000434-201810001-00104]
[66]
Bobrovitz N, Heneghan C, Onakpoya I, et al. Medications that reduce emergency hospital admissions: An overview of systematic reviews and prioritisation of treatments. BMC Med 2018; 16(1): 115.
[http://dx.doi.org/10.1186/s12916-018-1104-9] [PMID: 30045724]
[67]
Almeida MO, Yamato TP, Parreira PDCS, Costa LOP, Kamper S, Saragiotto BT. Overall confidence in the results of systematic reviews on exercise therapy for chronic low back pain: A cross-sectional analysis using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR)2 tool. Braz J Phys Ther 2019; (1): 1-15.
[http://dx.doi.org/10.1590/S1413-35552007000100002] [PMID: 31113734]
[68]
Singal AG, Higgins PDR, Waljee AK. A primer on effectiveness and efficacy trials. Clin Transl Gastroenterol 2014; 5(2): e45.
[http://dx.doi.org/10.1038/ctg.2013.13] [PMID: 24384867]
[69]
Nordon C, Karcher H, Groenwold RHH, et al. The “efficacy-effectiveness gap”: Historical background and current conceptualization. Value Health 2016; 19(1): 75-81.
[http://dx.doi.org/10.1016/j.jval.2015.09.2938] [PMID: 26797239]
[70]
Lehman AF, Thompson JW, Dixon LB, Scott JE. Schizophrenia: Treatment outcomes research-editors’ introduction. Schizophr Bull 1995; 21(4): 561-6.
[http://dx.doi.org/10.1093/schbul/21.4.561] [PMID: 8749884]
[71]
Templeton AJ, Booth CM, Tannock IF. Informing patients about expected outcomes: The efficacy-effectiveness gap. J Clin Oncol 2020; 38(15): 1651-4.
[http://dx.doi.org/10.1200/JCO.19.02035] [PMID: 32160103]
[72]
Schneeweiss S, Patrick AR, Stürmer T, et al. Increasing levels of restriction in pharmacoepidemiologic database studies of elderly and comparison with randomized trial results. Med Care 2007; 45(10) (Suppl. 2): S131-42.
[http://dx.doi.org/10.1097/MLR.0b013e318070c08e] [PMID: 17909372]
[73]
Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: A systematic review and meta-analysis. Lancet Infect Dis 2012; 12(1): 36-44.
[http://dx.doi.org/10.1016/S1473-3099(11)70295-X] [PMID: 22032844]
[74]
Dilokthornsakul P, Chaiyakunapruk N, Campbell JD. Does the use of efficacy or effectiveness evidence in cost-effectiveness analysis matter? J Asthma 2017; 54(1): 17-23.
[http://dx.doi.org/10.1080/02770903.2016.1193601] [PMID: 27284904]

Rights & Permissions Print Cite
Article Metrics
35
2
Wayfinder Image
© 2024 Bentham Science Publishers | Privacy Policy