Li Guanglu, Qu Baoquan, Zheng Tao, Duan Shaojie, Liu Lei, Liu Zunjing
Beijing University of Chinese Medicine, Beijing, China.
Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
Front Pharmacol. 2024 Dec 18;15:1496621. doi: 10.3389/fphar.2024.1496621. eCollection 2024.
While memantine has been considered a promising drug for migraine prevention, no conclusive evidence exists comparing its efficacy with other migraine-preventive medications. This network meta-analysis (NMA) aimed to access the effectiveness and acceptability of memantine and other guideline-recommended prophylactic agents for migraine.
We searched the Cochrane Register of Controlled Trials, Embase, PubMed, and ClinicalTrials databases from their inception to 1 June 2024. Randomized placebo-controlled trials (RCTs) examining the pharmacological prevention of adult migraine patients were included. The primary efficacy outcome was the change in migraine days, and the primary safety outcome was withdrawal due to adverse events. Secondary outcomes included 50% response rates and frequency of any adverse events. The analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Thirty-eight RCTs, including a total of 13,223 participants, were analyzed. Our analysis showed that memantine demonstrated the second-largest reduction in migraine days [standardized mean difference (SMD): -0.83; 95% confidence interval (CI): -1.26, -0.41 compared with placebo] and the highest 50% response rates [odds ratio (OR): 5.58, 95% CI: 1.31 to 23.69] in all studied interventions. Moreover, among all interventions, memantine appeared to show the lowest dropout rate and moderate frequency of adverse events. However, its confidence intervals contained null values.
This study provides prioritisation evidence for memantine in migraine prevention, as memantine can significantly decrease the frequency of migraine attacks, improves response rates, and fair acceptability. These beneficial effects were not inferior to currently recommended pharmacological regimens. However, due to the lack of long-term efficacy and safety data, as well as few direct comparisons with active control agents, the estimates of memantine may be overly optimistic. Clinicians should interpret the findings of current NMA cautiously and apply them in a relatively conservative manner.
虽然美金刚被认为是一种有前景的偏头痛预防药物，但尚无确凿证据将其疗效与其他偏头痛预防药物进行比较。这项网络荟萃分析（NMA）旨在评估美金刚及其他指南推荐的偏头痛预防药物的有效性和可接受性。
我们检索了Cochrane对照试验注册库、Embase、PubMed和ClinicalTrials数据库，检索时间从各数据库建库至2024年6月1日。纳入了检查成人偏头痛患者药物预防的随机安慰剂对照试验（RCT）。主要疗效指标是偏头痛天数的变化，主要安全性指标是因不良事件导致的退出。次要指标包括50%的缓解率和任何不良事件的发生频率。分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
共分析了38项RCT，包括13223名参与者。我们的分析表明，在所有研究的干预措施中，美金刚在减少偏头痛天数方面降幅第二大[标准化均值差（SMD）：-0.83；与安慰剂相比，95%置信区间（CI）：-1.26，-0.41]，且50%缓解率最高[比值比（OR）：5.58，95%CI：1.31至23.69]。此外，在所有干预措施中，美金刚的退出率似乎最低，不良事件发生频率适中。然而，其置信区间包含无效值。
本研究为美金刚在偏头痛预防中的应用提供了优先排序证据，因为美金刚可显著降低偏头痛发作频率，提高缓解率，并具有较好的可接受性。这些有益效果不低于目前推荐的药物治疗方案。然而，由于缺乏长期疗效和安全性数据，以及与活性对照药物的直接比较较少，美金刚的评估可能过于乐观。临床医生应谨慎解读当前NMA的结果，并以相对保守的方式应用这些结果。
