预防偏头痛药物的比较有效性荟萃分析

A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache.

作者信息

Jackson Jeffrey L, Cogbill Elizabeth, Santana-Davila Rafael, Eldredge Christina, Collier William, Gradall Andrew, Sehgal Neha, Kuester Jessica

机构信息

General Internal Medicine, Zablocki VA Medical Center, Milwaukee, Wisconsin, United States of America.

Department of Medicine, Western Michigan School of Medicine, Kalamazoo, Michigan, United States of America.

出版信息

PLoS One. 2015 Jul 14;10(7):e0130733. doi: 10.1371/journal.pone.0130733. eCollection 2015.

DOI:10.1371/journal.pone.0130733

PMID:26172390

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4501738/

Abstract

OBJECTIVE

To compare the effectiveness and side effects of migraine prophylactic medications.

DESIGN

We performed a network meta-analysis. Data were extracted independently in duplicate and quality was assessed using both the JADAD and Cochrane Risk of Bias instruments. Data were pooled and network meta-analysis performed using random effects models.

DATA SOURCES

PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 18 May 2014.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included randomized controlled trials of adults with migraine headaches of at least 4 weeks in duration.

RESULTS

Placebo controlled trials included alpha blockers (n = 9), angiotensin converting enzyme inhibitors (n = 3), angiotensin receptor blockers (n = 3), anticonvulsants (n = 32), beta-blockers (n = 39), calcium channel blockers (n = 12), flunarizine (n = 7), serotonin reuptake inhibitors (n = 6), serotonin norepinephrine reuptake inhibitors (n = 1) serotonin agonists (n = 9) and tricyclic antidepressants (n = 11). In addition there were 53 trials comparing different drugs. Drugs with at least 3 trials that were more effective than placebo for episodic migraines included amitriptyline (SMD: -1.2, 95% CI: -1.7 to -0.82), -flunarizine (-1.1 headaches/month (ha/month), 95% CI: -1.6 to -0.67), fluoxetine (SMD: -0.57, 95% CI: -0.97 to -0.17), metoprolol (-0.94 ha/month, 95% CI: -1.4 to -0.46), pizotifen (-0.43 ha/month, 95% CI: -0.6 to -0.21), propranolol (-1.3 ha/month, 95% CI: -2.0 to -0.62), topiramate (-1.1 ha/month, 95% CI: -1.9 to -0.73) and valproate (-1.5 ha/month, 95% CI: -2.1 to -0.8). Several effective drugs with less than 3 trials included: 3 ace inhibitors (enalapril, lisinopril, captopril), two angiotensin receptor blockers (candesartan, telmisartan), two anticonvulsants (lamotrigine, levetiracetam), and several beta-blockers (atenolol, bisoprolol, timolol). Network meta-analysis found amitriptyline to be better than several other medications including candesartan, fluoxetine, propranolol, topiramate and valproate and no different than atenolol, flunarizine, clomipramine or metoprolol.

CONCLUSION

Several drugs good evidence supporting efficacy. There is weak evidence supporting amitriptyline's superiority over some drugs. Selection of prophylactic medication should be tailored according to patient preferences, characteristics and side effect profiles.

摘要

目的

比较偏头痛预防性药物的疗效和副作用。

设计

我们进行了一项网状荟萃分析。数据由两人独立提取两次，并使用JADAD和Cochrane偏倚风险工具评估质量。数据进行汇总，并使用随机效应模型进行网状荟萃分析。

数据来源

PUBMED、EMBASE、Cochrane试验注册库，以及截至2014年5月18日检索文章的参考文献。

选择研究的纳入标准

我们纳入了针对成年偏头痛患者、持续时间至少4周的随机对照试验。

结果

安慰剂对照试验包括α受体阻滞剂（n = 9）、血管紧张素转换酶抑制剂（n = 3）、血管紧张素受体阻滞剂（n = 3）、抗惊厥药（n = 32）、β受体阻滞剂（n = 39）、钙通道阻滞剂（n = 12）、氟桂利嗪（n = 7）、5-羟色胺再摄取抑制剂（n = 6）、5-羟色胺去甲肾上腺素再摄取抑制剂（n = 1）、5-羟色胺激动剂（n = 9）和三环类抗抑郁药（n = 11）。此外，有53项试验比较了不同药物。对于发作性偏头痛，至少有3项试验显示比安慰剂更有效的药物包括阿米替林（标准化均数差：-1.2，95%可信区间：-1.7至-0.82）、氟桂利嗪（每月-1.1次头痛，95%可信区间：-1.6至-0.67）、氟西汀（标准化均数差：-0.57，95%可信区间：-0.97至-0.17）、美托洛尔（每月-0.94次头痛，95%可信区间：-1.4至-0.46）、苯噻啶（每月-0.43次头痛，95%可信区间：-0.6至-0.21）、普萘洛尔（每月-1.3次头痛）、托吡酯（每月-1.1次头痛）和丙戊酸盐（每月-1.5次头痛）。少于3项试验的几种有效药物包括：3种血管紧张素转换酶抑制剂（依那普利、赖诺普利、卡托普利）、2种血管紧张素受体阻滞剂（坎地沙坦、替米沙坦）、2种抗惊厥药（拉莫三嗪、左乙拉西坦），以及几种β受体阻滞剂（阿替洛尔、比索洛尔、噻吗洛尔）。网状荟萃分析发现，阿米替林优于包括坎地沙坦、氟西汀、普萘洛尔、托吡酯和丙戊酸盐在内的其他几种药物，与阿替洛尔、氟桂利嗪、氯米帕明或美托洛尔无差异。