Clinical effectiveness of pharmacological interventions for managing chronic migraine in adults: a systematic review and network meta-analysis

被引：16

作者：

Naghdi, Seyran ^{[1
]}

Underwood, Martin ^{[1
,2
]}

Madan, Jason ^{[1
]}

Brown, Anna ^{[3
]}

Duncan, Callum ^{[4
]}

Matharu, Manjit ^{[5
,6
]}

Aksentyte, Aiva ^{[1
]}

Davies, Natasha ^{[1
]}

Rees, Sophie ^{[7
]}

Cooklin, Andrew ^{[1
]}

Grove, Amy ^{[3
]}

Mistry, Hema ^{[1
,2
]}

机构：

[1] Univ Warwick, Warwick Med Sch, Warwick Clin Trials Unit, Gibbet Hill Rd, Coventry CV4 7AL, W Midlands, England

[2] Univ Hosp Coventry & Warwickshire NHS Trust, Neonatol, Coventry CV2 2DX, England

[3] Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry CV4 7AL, Warwickshire, England

[4] NHS Grampian, Aberdeen Royal Infirm, Dept Neurol, Aberdeen AB25 2ZN, Scotland

[5] Univ Coll London UCL, Queen Sq Inst Neurol, Headache & Facial Pain Grp, London, England

[6] Natl Hosp Neurol & Neurosurg, London WC1N 3BG, England

[7] Univ Bristol, Bristol Clin Trials Unit, Bristol BS8 1QU, England

来源：

JOURNAL OF HEADACHE AND PAIN | 2023年 / 24卷 / 01期

关键词：

QUALITY-OF-LIFE; PLACEBO-CONTROLLED TRIAL; DOUBLE-BLIND; PREVENTIVE TREATMENT; CONTROLLED PHASE; EFFICACY; TOPIRAMATE; SAFETY; ONABOTULINUMTOXINA; HEADACHE;

D O I：

10.1186/s10194-023-01696-w

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundChronic migraine can be a profoundly disabling disorder that may be treated with preventive medications. However, uncertainty remains as to which preventive medication is the most effective. We present a network meta-analysis to determine the effectiveness and rank of preventive drugs for chronic migraine in adults.MethodsWe identified, reviewed, and extracted data from randomised controlled trials (RCTs) of preventive drugs for chronic migraine with at least 200 participants. Data were analysed using network meta-analysis.FindingsWe included 12 RCTs of six medications (Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Onabotulinumtoxin A, and Topiramate) compared to placebo or each other. All drugs effectively reduced monthly headache and migraine days compared with placebo. The most effective drug for monthly headache days was Eptinezumab 300mg, with a mean difference of -2.46 days, 95% Credible Interval (CrI): -3.23 to -1.69. On the Surface Under the Cumulative Ranking Area (SUCRA) analysis, the probability that Eptinezumab 300mg was ranked highest was 0.82. For monthly migraine days, the most effective medication was Fremanezumab-monthly, with a mean difference: -2.77 days, 95% CrI: -3.36 to -2.17, and 0.98 probability of being ranked the highest. All included drugs, except Topiramate, improved headache-related quality of life. No eligible studies were identified for the other common preventive oral medications such as Amitriptyline, Candesartan, and Propranolol. The main reasons were that the studies did not define chronic migraine, were undertaken before the definition of chronic migraine, or were too small.InterpretationAll six medications were more effective than the placebo on monthly headache and migraine days. The absolute differences in the number of headache/migraine days are, at best, modest. No evidence was found to determine the relative effectiveness of the six included drugs with other oral preventive medications.RegistrationPROSPERO (number CRD42021265990).

引用

页数：10

共 58 条

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