成人慢性偏头痛药物干预管理的临床效果：系统评价和网络荟萃分析。
Clinical effectiveness of pharmacological interventions for managing chronic migraine in adults: a systematic review and network meta-analysis.
机构信息
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
出版信息
J Headache Pain. 2023 Dec 6;24(1):164. doi: 10.1186/s10194-023-01696-w.
BACKGROUND
Chronic migraine can be a profoundly disabling disorder that may be treated with preventive medications. However, uncertainty remains as to which preventive medication is the most effective. We present a network meta-analysis to determine the effectiveness and rank of preventive drugs for chronic migraine in adults.
METHODS
We identified, reviewed, and extracted data from randomised controlled trials (RCTs) of preventive drugs for chronic migraine with at least 200 participants. Data were analysed using network meta-analysis.
FINDINGS
We included 12 RCTs of six medications (Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Onabotulinumtoxin A, and Topiramate) compared to placebo or each other. All drugs effectively reduced monthly headache and migraine days compared with placebo. The most effective drug for monthly headache days was Eptinezumab 300mg, with a mean difference of -2.46 days, 95% Credible Interval (CrI): -3.23 to -1.69. On the Surface Under the Cumulative Ranking Area (SUCRA) analysis, the probability that Eptinezumab 300mg was ranked highest was 0.82. For monthly migraine days, the most effective medication was Fremanezumab-monthly, with a mean difference: -2.77 days, 95% CrI: -3.36 to -2.17, and 0.98 probability of being ranked the highest. All included drugs, except Topiramate, improved headache-related quality of life. No eligible studies were identified for the other common preventive oral medications such as Amitriptyline, Candesartan, and Propranolol. The main reasons were that the studies did not define chronic migraine, were undertaken before the definition of chronic migraine, or were too small.
INTERPRETATION
All six medications were more effective than the placebo on monthly headache and migraine days. The absolute differences in the number of headache/migraine days are, at best, modest. No evidence was found to determine the relative effectiveness of the six included drugs with other oral preventive medications.
REGISTRATION
PROSPERO (number CRD42021265990).
背景
慢性偏头痛可能是一种严重致残的疾病，可以用预防药物治疗。然而，哪种预防药物最有效仍存在不确定性。我们进行了一项网络荟萃分析，以确定成人慢性偏头痛预防药物的有效性和排名。
方法
我们从至少有 200 名参与者的慢性偏头痛预防药物的随机对照试验（RCT）中确定、审查和提取数据。使用网络荟萃分析对数据进行分析。
结果
我们纳入了 12 项 RCT，涉及 6 种药物（eptinezumab、erenumab、fremanezumab、galcanezumab、onabotulinumtoxin A 和 topiramate）与安慰剂或彼此比较。所有药物与安慰剂相比均能有效减少每月头痛和偏头痛天数。对于每月头痛天数，最有效的药物是 eptinezumab 300mg，平均差异为-2.46 天，95%可信区间（CrI）：-3.23 至-1.69。在表面累积排序区域（SUCRA）分析中，eptinezumab 300mg 排名最高的概率为 0.82。对于每月偏头痛天数，最有效的药物是 fremanezumab 每月一次，平均差异为-2.77 天，95% CrI：-3.36 至-2.17，以及 0.98 被排名最高的概率。除了 topiramate 之外，所有纳入的药物都改善了与头痛相关的生活质量。没有确定其他常见的预防口服药物（如阿米替林、坎地沙坦和普萘洛尔）的合格研究。主要原因是这些研究没有定义慢性偏头痛，是在慢性偏头痛定义之前进行的，或者规模太小。
解释
所有六种药物在每月头痛和偏头痛天数上都比安慰剂更有效。头痛/偏头痛天数的绝对差异最多只是适度的。没有证据表明可以确定六种包括药物与其他口服预防药物的相对有效性。
注册
PROSPERO（编号 CRD42021265990）。
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