偏头痛预防药物的疗效比较：系统评价和网络荟萃分析。
The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis.
机构信息
Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
Headache Medical Center Linz, Linz, Austria.
出版信息
J Headache Pain. 2023 May 19;24(1):56. doi: 10.1186/s10194-023-01594-1.
OBJECTIVE
While there are several trials that support the efficacy of various drugs for migraine prophylaxis against placebo, there is limited evidence addressing the comparative safety and efficacy of these drugs. We conducted a systematic review and network meta-analysis to facilitate comparison between drugs for migraine prophylaxis.
METHODS
We searched MEDLINE, EMBASE, CENTRAL, and clinicaltrials.gov from inception to August 13, 2022, for randomized trials of pharmacological treatments for migraine prophylaxis in adults. Reviewers worked independently and in duplicate to screen references, extract data, and assess risk of bias. We performed a frequentist random-effects network meta-analysis and rated the certainty (quality) of evidence as either high, moderate, low, or very low using the GRADE approach.
RESULTS
We identified 74 eligible trials, reporting on 32,990 patients. We found high certainty evidence that monoclonal antibodies acting on the calcitonin gene related peptide or its receptor (CGRP(r)mAbs), gepants, and topiramate increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo. We found moderate certainty evidence that beta-blockers, valproate, and amitriptyline increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, and low certainty evidence that gabapentin may not be different from placebo. We found high certainty evidence that, compared to placebo, valproate and amitriptyline lead to substantial adverse events leading to discontinuation, moderate certainty evidence that topiramate, beta-blockers, and gabapentin increase adverse events leading to discontinuation, and moderate to high certainty evidence that (CGRP(r)mAbs) and gepants do not increase adverse events.
CONCLUSIONS
(CGRP(r)mAbs) have the best safety and efficacy profile of all drugs for migraine prophylaxis, followed closely by gepants.
目的
虽然有几项试验支持各种预防偏头痛药物相对于安慰剂的疗效，但针对这些药物的相对安全性和疗效的证据有限。我们进行了一项系统评价和网络荟萃分析，以促进预防偏头痛药物之间的比较。
方法
我们从建库至 2022 年 8 月 13 日，在 MEDLINE、EMBASE、CENTRAL 和 clinicaltrials.gov 上检索了成人预防偏头痛药物的随机试验，检索了治疗偏头痛的药物的随机对照试验。审查员独立并重复筛选参考文献、提取数据和评估偏倚风险。我们进行了频率论随机效应网络荟萃分析，并使用 GRADE 方法将证据的确定性（质量）评为高、中、低或极低。
结果
我们确定了 74 项合格试验，共报告了 32990 名患者。我们发现高确定性证据表明，作用于降钙素基因相关肽或其受体（CGRP(r)mAbs）、依普替肽和托吡酯的单克隆抗体与安慰剂相比，增加了经历每月偏头痛天数减少 50%或更多的患者比例。我们发现中等确定性证据表明，β-受体阻滞剂、丙戊酸钠和阿米替林增加了经历每月偏头痛天数减少 50%或更多的患者比例，而低确定性证据表明加巴喷丁与安慰剂可能没有差异。我们发现高确定性证据表明，与安慰剂相比，丙戊酸钠和阿米替林导致停药相关的不良事件大量增加，中等确定性证据表明托吡酯、β-受体阻滞剂和加巴喷丁增加了停药相关的不良事件，而中等至高度确定性证据表明（CGRP(r)mAbs）和依普替肽不会增加不良事件。
结论
（CGRP(r)mAbs）在预防偏头痛的所有药物中具有最佳的安全性和疗效，紧随其后的是依普替肽。
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