Hasan Abdi Sayed Aliul, Sayed Shabihul Fatma, Bhaskar Jamuna
Clinical Research and Excellence Team, Qurhealth Solutions, Chennai 603 103, Tamil Nadu, India.
Ann Indian Acad Neurol. 2022 Jul-Aug;25(4):669-675. doi: 10.4103/aian.aian_972_21. Epub 2022 Sep 9.
Migraine may be an important factor for paresthesia in the limbs, especially in the upper limbs. In several patients, paresthesia is responsible for a low quality of life. Treatment with the serotonin agonist may be a triggering factor for paresthesia in certain patients. Various serotonin receptor agonists are available for migraine treatment. We performed a meta-analysis of updated clinical trials of the serotonin agonist to figure out the risk of paresthesia.
PubMed, Embase, and Cochrane Library databases were searched for clinical trials that evaluated the serotonin agonist for migraine treatment versus placebo. The main outcomes were to perform dose-response model-based network meta-analysis of different serotonin agonists and to compute the relative risk for paresthesia. In addition, probability of paresthesia among various treatments was estimated by the Surface Under the Cumulative Ranking (SUCRA) method. The R 4.30 and Rev Man 5.3 softwares were used to perform meta-analysis.
A total of 30 placebo-controlled clinical trials (29,154 subjects) were included in the study to perform dose-response model-based network meta-analysis to explore the risk of paresthesia with different serotonin agonists versus placebo. The drugs Topiramate 200 mg, Lasmiditan 400 mg, and Zolmitriptan 10 mg showed higher relative risks for paraesthesia as 2.71, 2.2, and 2.42, respectively. However, the SUCRA probabilities of paresthesia for each treatment in the network were higher for Lasmiditan.
This meta-analysis of reported placebo-controlled clinical trials suggests that the SUCRA probabilities for the manifestation of paresthesia are higher with Lasmiditan. The relative risk of paresthesia is higher with the use of Topiramate 200 mg, Lasmiditan 400 mg, and Zolmitriptan 10 mg. In addition, Lasmiditan exhibited a gradual dose-response of relative risk for the manifestation of paresthesia.
偏头痛可能是肢体感觉异常的一个重要因素，尤其是在上肢。在一些患者中，感觉异常会导致生活质量低下。5-羟色胺激动剂治疗可能是某些患者感觉异常的触发因素。有多种5-羟色胺受体激动剂可用于偏头痛治疗。我们对5-羟色胺激动剂的最新临床试验进行了荟萃分析，以确定感觉异常的风险。
在PubMed、Embase和Cochrane图书馆数据库中检索评估5-羟色胺激动剂治疗偏头痛与安慰剂对照的临床试验。主要结果是对不同5-羟色胺激动剂进行基于剂量反应模型的网络荟萃分析，并计算感觉异常的相对风险。此外，通过累积排名曲线下面积（SUCRA）方法估计各种治疗中感觉异常的概率。使用R 4.30和Rev Man 5.3软件进行荟萃分析。
本研究共纳入30项安慰剂对照临床试验（29154名受试者），进行基于剂量反应模型的网络荟萃分析，以探讨不同5-羟色胺激动剂与安慰剂相比感觉异常的风险。200mg托吡酯、400mg拉米替坦和10mg佐米曲普坦的感觉异常相对风险较高，分别为2.71、2.2和2.42。然而，网络中每种治疗的感觉异常SUCRA概率以拉米替坦为高。
这项对已报道的安慰剂对照临床试验的荟萃分析表明，拉米替坦出现感觉异常的SUCRA概率较高。使用200mg托吡酯、400mg拉米替坦和10mg佐米曲普坦时感觉异常的相对风险较高。此外，拉米替坦在感觉异常表现方面呈现相对风险的逐渐剂量反应关系。
