Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
Ann Med. 2024 Dec;56(1):2357235. doi: 10.1080/07853890.2024.2357235. Epub 2024 May 30.
Tension-type headache is the most common type of primary headache and results in a huge socioeconomic burden. This network meta-analysis (NMA) aimed to compare the efficacy and safety of simple analgesics for the treatment of episodic tension-type headache (ETTH) in adults.
We searched the Cochrane Library, PubMed, Web of Science, Embase, Chinese BioMedical Literature database and International Clinical Trials Registry Platform databases for eligible randomized clinical trials reporting the efficacy and/or safety of simple analgesics. A Bayesian NMA was performed to compare relative efficacy and safety. The surface under the cumulative ranking curve (SUCRA) was calculated to rank interventions. PROSPERO registration number: CRD42018090554.
We highlighted six studies including 3507 patients. For the 2 h pain-free rate, the SUCRA ranking was ibuprofen > diclofenac-K > ketoprofen > acetaminophen > naproxen > placebo. All drugs except naproxen reported a higher 2 h pain-free rate than placebo, with a risk ratio (RR) of 2.86 (95% credible interval, CrI: 1.62-5.42) for ibuprofen and 2.61 (1.53-4.88) for diclofenac-K. For adverse events rate, the SUCRA ranking was: metamizol > diclofenac-K > ibuprofen > lumiracoxib > placebo > aspirin > acetaminophen > naproxen > ketoprofen. The adverse event rates of all analgesics were no higher than those of placebo, except for ketoprofen. Moreover, all drugs were superior to placebo in the global assessment of efficacy. In particular, the RR of lumiracoxib was 2.47 (1.57-4.57). Global heterogeneity between the studies was low.
Simple analgesics are considered more effective and safe as a placebo for ETTH in adults. Our results suggest that ibuprofen and diclofenac-K may be the two best treatment options for patients with ETTH from a comprehensive point of view (both high-quality evidence).
紧张型头痛是最常见的原发性头痛，会造成巨大的社会经济负担。本网络荟萃分析（NMA）旨在比较简单镇痛药治疗成人发作性紧张型头痛（ETTH）的疗效和安全性。
我们检索了 Cochrane 图书馆、PubMed、Web of Science、Embase、中国生物医学文献数据库和国际临床试验注册平台数据库，以获取报告简单镇痛药疗效和/或安全性的合格随机临床试验。采用贝叶斯 NMA 比较相对疗效和安全性。计算累积排序曲线下面积（SUCRA）以对干预措施进行排名。PROSPERO 注册号：CRD42018090554。
我们重点介绍了 6 项研究，共纳入 3507 名患者。对于 2 小时无痛率，SUCRA 排名为布洛芬＞双氯芬酸钾＞酮洛芬＞对乙酰氨基酚＞萘普生＞安慰剂。除萘普生外，所有药物的 2 小时无痛率均高于安慰剂，布洛芬的风险比（RR）为 2.86（95%可信区间，CrI：1.62-5.42），双氯芬酸钾为 2.61（1.53-4.88）。对于不良事件发生率，SUCRA 排名为：扑热息痛＞双氯芬酸钾＞布洛芬＞鲁米昔布＞安慰剂＞阿司匹林＞对乙酰氨基酚＞萘普生＞酮洛芬。所有镇痛药的不良事件发生率均低于安慰剂，除了酮洛芬。此外，所有药物在疗效的整体评估中均优于安慰剂。特别是，鲁米昔布的 RR 为 2.47（1.57-4.57）。研究之间的整体异质性较低。
与安慰剂相比，简单镇痛药被认为对成人 ETTH 更有效且更安全。我们的结果表明，从综合角度来看，布洛芬和双氯芬酸钾可能是 ETTH 患者的两种最佳治疗选择（均为高质量证据）。
