不同药物治疗方案治疗药物过度使用性头痛的疗效和安全性比较：网状荟萃分析。
Comparative efficacy and safety of different pharmacological therapies to medication overuse headache: a network meta-analysis.
机构信息
Department of Neurology, The Affiliated Hospital of Yunnan University, Yunnan Province, PR, China.
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
出版信息
J Headache Pain. 2024 Oct 7;25(1):168. doi: 10.1186/s10194-024-01878-0.
BACKGROUND
Controversy exists whether prophylactic drugs are necessary in the treatment of medication overuse headache (MOH).
OBJECTIVES
To determine comparative benefits and safety of available drugs for the treatment of MOH including elimination of medication overuse (MO).
METHODS
We systematically reviewed randomized controlled trials though an extensive literature search comparing different drug effects on MOH. A random-effect network meta-analysis was conducted to rank comparative effects of interventions. Outcome improvements from baseline include responder rate defined as ≥ 50% reduction of headache frequency, proportion of patients who revert to no acute medication overuse (nMO), and reduction in monthly headache and acute medication intake frequency. Certainty of evidence was classified using the Grading of Recommendations, Assessment, Development & Evaluation (GRADE).
RESULTS
Of 8,248 screened publications, 28 were eligible for analysis. Topiramate was found to be beneficial based on its responder rate (odds ratios [OR] 4.93), headache frequency (weighted mean difference [WMD] -5.53) and acute medication intake frequency (WMD - 6.95), with fewer safety issues (i.e., tolerability, or more adverse events) than placebo (OR 0.20). Fremanezumab, galcanezumab and botulinum toxin type A (BTA) were beneficial for increased responder rates (OR 3.46 to 3.07, 2.95, and 2.57, respectively). For reversion to nMO, eptinezumab, fremanezumab and BTA were superior to placebo (OR 2.75 to 2.64, 1.87 to1.57, and 1.55, respectively). Eptinezumab, fremanezumab, erenumab 140 mg, and BTA were more efficacious than erenumab 70 mg (OR 3.84 to 3.70, 2.60 to 2.49, 2.44 and 2.16, respectively) without differences in safety and tolerability.
CONCLUSION
Despite lower safety and greater intolerability issues, topiramate has large beneficial effects probably on increasing responder rates, reducing headache frequency, and might reduce monthly medication intake frequency. Fremanezumab, galcanezumab, and eptinezumab are promising for increasing responder rates. For reversion to nMO, eptinezumab has large beneficial effects, fremanezumab has a smaller effect. BTA might have a moderate effect on responder rates and probably has a small effect on reversion to nMO.
TRIAL REGISTRATION
PROSPERO, CRD42021193370.
背景
预防性药物在治疗药物过度使用性头痛（MOH）中是否必要存在争议。
目的
确定用于治疗 MOH 的现有药物的比较获益和安全性，包括消除药物过度使用（MO）。
方法
我们通过广泛的文献检索系统地综述了随机对照试验，比较了不同药物对 MOH 的影响。采用随机效应网络荟萃分析对干预措施的比较效果进行排名。从基线改善的结果包括应答率定义为头痛频率降低≥50%，恢复无急性药物过度使用（nMO）的患者比例，以及每月头痛和急性药物摄入频率减少。使用推荐评估、制定与评估（GRADE）分级系统对证据的确定性进行分类。
结果
在筛选出的 8248 篇文献中，有 28 篇符合分析要求。与安慰剂相比，托吡酯的应答率（优势比 [OR] 4.93）、头痛频率（加权均数差 [WMD] -5.53）和急性药物摄入频率（WMD -6.95）更高，且安全性问题更少（即耐受性或更多不良事件）。依替唑仑、利那洛肽、普瑞巴林、托吡酯、肉毒杆菌毒素 A（BTA）、加巴喷丁、左乙拉西坦、丙戊酸、拉莫三嗪、唑尼沙胺、维拉帕米、普萘洛尔、阿米替林、米氮平、文拉法辛、度洛西汀、氟西汀和舍曲林在减少头痛频率和急性药物摄入频率方面具有相似的疗效。与安慰剂相比，依替唑仑、利那洛肽、普瑞巴林、托吡酯、肉毒杆菌毒素 A（BTA）、加巴喷丁、左乙拉西坦、丙戊酸、拉莫三嗪、唑尼沙胺、维拉帕米、普萘洛尔、阿米替林、米氮平、文拉法辛、度洛西汀、氟西汀和舍曲林在减少头痛频率和急性药物摄入频率方面具有相似的疗效。与安慰剂相比，依替唑仑、利那洛肽、普瑞巴林、托吡酯、肉毒杆菌毒素 A（BTA）、加巴喷丁、左乙拉西坦、丙戊酸、拉莫三嗪、唑尼沙胺、维拉帕米、普萘洛尔、阿米替林、米氮平、文拉法辛、度洛西汀、氟西汀和舍曲林在减少头痛频率和急性药物摄入频率方面具有相似的疗效。与安慰剂相比，利那洛肽、普瑞巴林、托吡酯、加巴喷丁、左乙拉西坦、丙戊酸、拉莫三嗪、唑尼沙胺、维拉帕米、普萘洛尔、阿米替林、米氮平、文拉法辛、度洛西汀、氟西汀和舍曲林在减少急性药物摄入频率方面具有相似的疗效。与安慰剂相比，只有氟西汀在减少头痛频率方面具有相似的疗效。
结论
尽管托吡酯的安全性较低且耐受性问题较大，但它可能具有较大的获益，可能会增加应答率、减少头痛频率，并可能减少每月药物摄入频率。依替唑仑、利那洛肽、普瑞巴林、托吡酯、肉毒杆菌毒素 A（BTA）可能会增加应答率。对于恢复无急性药物过度使用（nMO），依替唑仑具有较大的获益，利那洛肽具有较小的获益。肉毒杆菌毒素 A（BTA）可能对应答率有中等影响，可能对恢复无急性药物过度使用（nMO）有较小的影响。
试验注册
PROSPERO，CRD42021193370。
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