CGRP-antibodies, topiramate and botulinum toxin type A in episodic and chronic migraine: A systematic review and meta-analysis

被引:42
作者
Frank, Florian [1 ]
Ulmer, Hanno [2 ]
Sidoroff, Victoria [1 ]
Broessner, Gregor [1 ]
机构
[1] Innsbruck Med Univ, Dept Neurol, Innsbruck, Austria
[2] Innsbruck Med Univ, Dept Med Stat Informat & Hlth Econ, Innsbruck, Austria
关键词
Migraine disorders; prevention; treatment; efficacy; responder rate; outcome; DOUBLE-BLIND; PREVENTIVE TREATMENT; PROPHYLACTIC TREATMENT; CONTROLLED-TRIAL; PLACEBO; EFFICACY; SAFETY; MULTICENTER; TOLERABILITY; PREVALENCE;
D O I
10.1177/03331024211018137
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background The approval of monoclonal antibodies for prevention of migraine has revolutionized treatment for patients. Oral preventatives are still considered first line treatments as head-to-head trials comparing them with antibodies are lacking. Methods The main purpose of this study was to provide a comparative overview of the efficacy of three commonly prescribed migraine preventative medication classes. For this systematic review and meta-analysis, we searched the databases CENTRAL, EMBASE, and MEDLINE until 20 March 2020. We included RCTs reporting the 50% response rates for topiramate, Botulinum Toxin Type A and monoclonal antibodies against CGRP(r). Studies were excluded if response rates were not reported, treatment allocation was unclear, or if study quality was insufficient. Primary outcome measure were the 50% response rates. The pooled odds ratios with 95% confidence intervals were calculated with the random effects model. The study was registered at PROSPERO (CRD42020222880). Findings We identified 6552 reports. Thirty-two were eligible for our review. Studies assessing monoclonal antibodies included 13,302 patients and yielded pooled odds ratios for the 50% response rate of 2.30 (CI: 2.11-2.50). Topiramate had an overall effect estimate of 2.70 (CI: 1.97-3.69) with 1989 included patients and Botulinum Toxin Type A achieved 1.28 (CI: 0.98-1. 67) with 2472 patients included. Interpretation Topiramate, botulinum toxin type A and monoclonal antibodies showed higher odds ratios in achieving a 50% response rate compared to placebo. Topiramate numerically demonstrated the greatest effect size but also the highest drop-out rate.
引用
收藏
页码:1222 / 1239
页数:18
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