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Table 4 Quality of evidence of the reviews included according to GRADE

From: Comparing the efficacy and safety of duloxetine and amitriptyline in the treatment of fibromyalgia: overview of systematic reviews

  Impact Confidence Importance
No. studies Study design Risk of Bias Inconsistency Indirect evidence Imprecision Other considerations   
Pain
 8 SR of CT Not serious Serious a Not serious Not serious Highly suspicious Favors AMT ++
Low
Critical
Sleep
 6 SR of CT Not serious Serious a Not serious Not serious None Favors AMT +++
Moderate
Critical
Fatigue
 7 SR of CT Not serious Not serious Not serious Not serious Highly-suspicious publication bias Favors AMT +++
Moderate
Critical
Mood Disorder
 4 SR of CT Not serious Not serious Not serious Not serious None Favors DLX ++++
High
Critical
Quality of life
 5 SR of CT Not serious Not serious Not serious Not serious None Favors AMT ++++
High
Critical
Safety and acceptability
 7 SR of CT Not serious Serious b Not serious Not serious Highly suspicious publication bias DLX with higher acceptability and safety for elderlies; AMT with higher safety for non-elderlies ++
Low
Critical
  1. SR Systematic Review, CT Clinical Trial; a most of the reviews do no detail the results of the heterogeneity tests and, in some of them, the rates were high; b diverging results with rare approaches to explain heterogeneity; scarce safety data; AMT Amitriptyline, DLX Duloxetine