Faculty of Medicine, Fayoum University, Fayoum, Egypt; SevoClin Research Group, Cairo, Egypt.
SevoClin Research Group, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
J Neurol Sci. 2021 Aug 15;427:117505. doi: 10.1016/j.jns.2021.117505. Epub 2021 May 21.
The Global burden of disease study ranked migraine as the sixth most common disorder worldwide in 2016, with significant social and economic sequelae. In this study, we assessed the efficacy of different Calcitonin gene-related peptide (CGRP) receptor blockers as potential pharmacological approaches and compare them to placebo using the systematic review (SR) and network meta-analysis (NMA) approach. We performed a computerized search of SCOPUS, PubMed, Cochrane central, and Embase databases through January 2019 and included randomized controlled trials (RCTs), which were performed on episodic and chronic migraine patients who used Erenumab, Eptinezumab, Fremanezumab, or Galcanezumab. The combined analysis revealed that after six, eight, and twelve weeks of intervention, the medications with the most potent effects in comparison to placebo were Fremanezumab 900 mg, (SMD = -0.55, 95% CI [-0.97, -0.12]); Erenumab 140 mg, (SMD = -0.51, 95% CI [-0.61, 0.41]); and Erenumab 140 mg, (SMD = -0.48, 95% CI [-0.571, 0.39]), respectively. For chronic migraine patients, Fremanezumab 900 mg, Erenumab 140 mg, in addition to Erenumab 70 mg, were associated with the highest efficacy after 6, 8, and 12 weeks, correspondingly. The analysis of combined groups data (Chronic and Episodic) showed that Fremanezumab was the most effective drug after six weeks, where Erenumab was the most effective after 8 and 12 weeks. The current evidence retrieved from this NMA suggests that Fremanezumab was the most effective anti-migraine medication in decreasing MHDs per month after six weeks in both chronic and episodic patients.
全球疾病负担研究将偏头痛列为 2016 年全球第六大常见疾病，其具有显著的社会和经济后果。在本研究中，我们评估了不同降钙素基因相关肽（CGRP）受体阻滞剂作为潜在药物治疗方法的疗效，并通过系统评价（SR）和网络荟萃分析（NMA）方法将其与安慰剂进行比较。我们通过计算机检索 SCOPUS、PubMed、Cochrane 中心和 Embase 数据库，检索时间截至 2019 年 1 月，纳入了针对发作性和慢性偏头痛患者的随机对照试验（RCT），这些患者使用了 Erenumab、Eptinezumab、Fremanezumab 或 Galcanezumab。综合分析显示，在干预后 6、8 和 12 周时，与安慰剂相比，药物效果最强的是 Fremanezumab 900mg（SMD=-0.55，95%CI[-0.97，-0.12]）、Erenumab 140mg（SMD=-0.51，95%CI[-0.61，0.41]）和 Erenumab 140mg（SMD=-0.48，95%CI[-0.571，0.39]）。对于慢性偏头痛患者，Fremanezumab 900mg、Erenumab 140mg 以及 Erenumab 70mg 在 6、8 和 12 周后均具有最高的疗效。合并组数据（慢性和发作性）分析显示，Fremanezumab 在 6 周后是最有效的药物，而 Erenumab 在 8 和 12 周后是最有效的药物。本 NMA 检索到的现有证据表明，Fremanezumab 在慢性和发作性患者中，在第 6 周时每月偏头痛天数（MHDs）减少量最大，是最有效的抗偏头痛药物。
