Hepp Zsolt, Bloudek Lisa M, Varon Sepideh F
Global Health Outcomes Strategy and Research, Allergan, 2525 Dupont Dr., MI3-110A, Irvine, CA 92612, USA.
J Manag Care Pharm. 2014 Jan;20(1):22-33. doi: 10.18553/jmcp.2014.20.1.22.
Migraine is a common neurological disease affecting 12% of Americans and millions worldwide. Medication adherence has been studied extensively in many chronic conditions, with poor adherence adversely affecting treatment outcomes. However, little is known about adherence to oral prophylaxis for migraine.
To examine the literature on assessing oral prophylaxis medication adherence and persistence among migraine patients.
A systematic search of the PubMed (1966 to present) and EMBASE (1974 to present) databases was conducted to locate prospective and retrospective observational studies and randomized controlled trials (RCTs) of propranolol, amitriptyline, and topiramate. RCTs were pooled, weighted by sample size, and stratified by drug and length of study. Average persistence rates and reasons for discontinuation cited in RCTs were examined for each medication.
A total of 788 unique articles were identified using the search criteria, 33 of which were included in the final review. Observational studies (n = 14) showed adherence ranges of 41% to 95% at 2 months, 21% to 80% at 6 months, and 35% to 56% at 12 months and persistence ranges of 41% to 88% at 2 months, 19% to 79% at 6 months, and 7% to 55% at 12 months. Pooled persistence from RCTs on propranolol, amitriptyline, and topiramate (n = 19) showed rates of 77%, 55%, and 57%, respectively, at 16-26 weeks. Adverse events were the most common reason for discontinuation cited (24% for topiramate and 17% for amitriptyline).
Observational studies and pooled data from RCTs demonstrate poor adherence and persistence to oral migraine prophylaxis.
偏头痛是一种常见的神经系统疾病，影响着12%的美国人以及全球数百万人。在许多慢性病中，药物依从性已得到广泛研究，依从性差会对治疗结果产生不利影响。然而，对于偏头痛口服预防性治疗的依从性知之甚少。
研究评估偏头痛患者口服预防性药物依从性和持续性的相关文献。
对PubMed（1966年至今）和EMBASE（1974年至今）数据库进行系统检索，以查找关于普萘洛尔、阿米替林和托吡酯的前瞻性和回顾性观察性研究以及随机对照试验（RCT）。对RCT进行汇总，按样本量加权，并按药物和研究时长分层。检查每项药物在RCT中引用的平均持续率和停药原因。
使用检索标准共识别出788篇独特文章，其中33篇纳入最终综述。观察性研究（n = 14）显示，2个月时依从率范围为41%至95%，6个月时为21%至80%，12个月时为35%至56%；2个月时持续率范围为41%至88%，6个月时为19%至79%，12个月时为7%至55%。关于普萘洛尔、阿米替林和托吡酯的RCT（n = 19）汇总持续率显示，在16 - 26周时分别为77%、55%和57%。不良事件是最常被提及的停药原因（托吡酯为24%，阿米替林为17%）。
观察性研究和RCT汇总数据表明，偏头痛口服预防性治疗的依从性和持续性较差。
