. 2023 May 10;2023(5):CD014682. doi: 10.1002/14651858.CD014682.pub2

31. Withdrawal summary of findings.

Estimates of effects, credible intervals, and certainty of the evidence for withdrawal from studies in people with chronic pain
Bayesian network meta‐analysis summary of findings table
Patient or population: people with chronic pain Interventions: amitriptyline, desipramine, desvenlafaxine, duloxetine, esreboxetine, milnacipran, mirtazapine, nortriptyline, paroxetine, venlafaxine. All doses were combined for each antidepressant. Comparator (reference): placebo Outcome: withdrawal from the study (for any reason) Direction: lower is better (i.e. fewer people withdrawing from studies)
Total studies: 152 Total participants: 28120	Relative effect (OR and 95% CI)	Anticipated absolute effect (event rate)*			Certainty of the evidence (GRADE)	Ranking (2.5% to 97.5% credible interval)**	Interpretation of findings
Total studies: 152 Total participants: 28120	Relative effect (OR and 95% CI)	With placebo	With intervention	Difference	Certainty of the evidence (GRADE)	Ranking (2.5% to 97.5% credible interval)**	Interpretation of findings
Nortriptyline RCTs: 7 Participants: 612	0.54 (0.09 to 1.17)	101 per 1000	57 per 1000	44 fewer per 1000 (111 fewer to 15 more)	Very low^a,b	13 (5 to 26)	Not significantly different from placebo
Mirtazapine RCTs: 3 Participants: 510	0.99 (0.34 to 1.64)	120 per 1000	119 per 1000	1 fewer per 1000 (76 fewer to 63 more)	Very low^b,c	28 (11 to 52)	Not significantly different from placebo
Amitriptyline RCTs: 34 Participants: 2126	1.12 (0.85 to 1.39)	138 per 1000	152 per 1000	14 more per 1000 (18 fewer to 44 more)	Very low^a,b,c	31 (20 to 43)	Not significantly different from placebo
Duloxetine RCTs: 45 Participants: 10140	1.20 (1.06 to 1.34)	207 per 1000	239 per 1000	32 more per 1000 (10 more to 52 more)	Low^a,b	33 (24 to 43)	Equivalent to NNTH of 31
Desvenlafaxine RCTs: 2 Participants: 1105	1.25 (0.82 to 1.68)	450 per 1000	506 per 1000	56 more per 1000 (48 fewer to 129 more)	Very low^a,b,c	35 (19 to 53)	Not significantly different from placebo
Milnacipran RCTs: 17 Participants: 5088	1.34 (1.12 to 1.56)	254 per 1000	314 per 1000	59 more per 1000 (22 more to 93 more)	Very low^a,b	38 (27 to 49)	Equivalent to NNTH of 17
Venlafaxine RCTs: 6 Participants: 624	140 (0.91 to 1.89)	158 per 1000	208 per 1000	50 more per 1000 (12 fewer to 104 more)	Very low^a,b,c	40 (21 to 59)	Not significantly different from placebo
Esreboxetine RCTs: 2 Participants: 1389	1.42 (1.01 to 1.83)	251 per 1000	322 per 1000	71 more per 1000 (2 more to 129 more)	Very low^a,b,c	41 (23 to 56)	Equivalent to NNTH of 31
Desipramine RCTs: 4 Participants: 368	1.57 (1.02 to 2.12)	196 per 1000	276 per 1000	81 more per 1000 (3 more to 145 more)	Very low^a,b,c	44 (24 to 61)	Equivalent to NNTH of 14
Paroxetine RCTs: 9 Participants: 568	1.68 (1.23 to 2.12)	173 per 1000	260 per 1000	87 more per 1000 (32 more to 134 more)	Very low^a,b	46 (28 to 60)	Equivalent to NNTH of 11
Network meta‐analysis‐summary of findings table definitions * Anticipated absolute effect. Anticipated absolute effect compares two risks by calculating the difference between the risk of the intervention group with the risk of the control group. Mean and credible intervals are presented. Rank statistics is defined as the probabilities that a treatment out of n treatments in a network meta‐analysis is the best, the second, the third and so on until the least effective treatment. CI: confidence interval; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RCT:** randomised controlled trial The number of participants for each antidepressant reflects the total number of participants taking the antidepressant or placebo from the studies in the network meta‐analysis.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

^aDowngraded due to within‐study bias. ^bDowngraded due to imprecision in the estimate. ^cDowngraded due to heterogeneity in the estimate. ^dDowngraded due to incoherence in the network. ^eDowngraded due to a small number of trials and participants; we cannot draw reliable conclusions.