Headache Group, Wolfson CARD, SLaM Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London and NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, United Kingdom.
Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark.
Cephalalgia. 2023 Mar;43(3):3331024231151419. doi: 10.1177/03331024231151419.
We performed a random-effects network meta-analysis to study the efficacy and safety of newly developed drugs for the acute treatment of migraine attacks.
MEDLINE via PubMed, Embase and The Cochrane Register of Controlled Trials were searched from inception to 11 February 2022. Phase 3 randomized controlled trials examining all formulations of lasmiditan, rimegepant and ubrogepant for the acute treatment of adults with migraine, were included. Data were extracted following the PRISMA guidelines.
Seven studies (SAMURAI, SPARTAN, CENTURION, Study 302, Study 303, ACHIEVE I and II) involving = 12,859 patients were included. All treatments were superior in efficacy to placebo. Lasmiditan 200 mg showed the highest two-hour pain freedom, while two-hour freedom from most bothersome symptom was equally achieved by the higher doses of lasmiditan (100 and 200 mg), rimegepant and the higher doses of ubrogepant (50 and 100 mg). The odds of treatment-emergent adverse events were greatest with all doses of lasmiditan.
Lasmiditan 200 mg was the most effective intervention in the treatment of migraine attacks, although it was associated with high degrees of dizziness, nausea and somnolence. Rimegepant showed slightly lower, but similar efficacy rates to lasmiditan. Ubrogepant had overall the best tolerability profile. These conclusions are limited by the absence of head-to-head comparisons, limitations of individual trials and of the meta-analysis methodology itself. CRD42022308224.
我们进行了一项网状荟萃分析，以研究新开发的用于急性偏头痛治疗的药物的疗效和安全性。
从建库至 2022 年 2 月 11 日，我们通过 MEDLINE（PubMed 数据库）、Embase 和 Cochrane 对照试验登记库检索了相关文献。纳入了评估拉米替坦、rimegepant 和ubrogepant 所有剂型用于急性治疗偏头痛的成人的 3 期随机对照试验。根据 PRISMA 指南提取数据。
纳入了 7 项研究（SAMURAI、SPARTAN、CENTURION、Study 302、Study 303、ACHIEVE I 和 II），共涉及 12859 例患者。所有治疗均优于安慰剂。拉米替坦 200mg 在两小时时的疼痛缓解率最高，而较高剂量的拉米替坦（100mg 和 200mg）、rimegepant 和较高剂量的 ubrogepant（50mg 和 100mg）同样可在两小时时实现最恼人症状的缓解。拉米替坦所有剂量的治疗后新发不良事件发生率最高。
拉米替坦 200mg 是治疗偏头痛发作最有效的干预措施，尽管其与较高程度的头晕、恶心和嗜睡相关。rimegepant 的疗效率略低于拉米替坦，但相似。ubrogepant 的总体耐受性最好。这些结论受到缺乏头对头比较、单个试验的局限性以及荟萃分析方法本身的局限性的限制。CRD42022308224。
