Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta‐Analysis

Headache - Tập 55 Số S4 - Trang 221-235 - 2015
Chris Cameron1,2, Shannon Kelly2, Shu‐Ching Hsieh2, Meghan Murphy2, Li Chen2, Ahmed Kotb2, Joan Peterson2, Doug Coyle1, Becky Skidmore2, Tara Gomes3, Tammy Clifford4,1, George A. Wells1,2
1School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
2University of Ottawa Heart Institute, Ottawa, Canada
3Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
4CADTH, Ottawa, Canada

Tóm tắt

BackgroundAlthough triptans are widely used in the acute management of migraine, there is uncertainty around the comparative efficacy of triptans among each other and vs non‐triptan migraine treatments. We conducted systematic reviews and network meta‐analyses to compare the relative efficacy of triptans (alone or in combination with other drugs) for acute treatment of migraines compared with other triptan agents, non‐steroidal anti‐inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), acetaminophen, ergots, opioids, or anti‐emetics.MethodsThe Cochrane Library, MEDLINE, and EMBASE were searched for randomized controlled trials that compared triptans (alone or in combination with other drugs) with placebo‐controlled or active migraine treatments. Study selection, data extraction, and quality assessment were completed independently by multiple reviewers. Outcome data were combined and analyzed using a Bayesian network meta‐analysis. For each outcome, odds ratios, relative risks, and absolute probability of response were calculated.ResultsA total of 133 randomized controlled trials met the inclusion criteria. Standard dose triptans relieved headaches within 2 hours in 42 to 76% of patients, and 2‐hour sustained freedom from pain was achieved for 18 to 50% of patients. Standard dose triptans provided sustained headache relief at 24 hours in 29 to 50% of patients, and sustained freedom from pain in 18 to 33% of patients. Use of rescue medications ranged from 20 to 34%. For 2‐hour headache relief, standard dose triptan achieved better outcomes (42 to 76% response) than ergots (38%); equal or better outcomes than NSAIDs, ASA, and acetaminophen (46 to 52%); and equal or slightly worse outcomes than combination therapy (62 to 80%). Among individual triptans, sumatriptan subcutaneous injection, rizatriptan ODT, zolmitriptan ODT, and eletriptan tablets were associated with the most favorable outcomes.Interpretation/ConclusionsTriptans are effective for migraine relief. Standard dose triptans are associated with better outcomes than ergots, and most triptans are associated with equal or better outcomes compared with NSAIDs, ASA, and acetaminophen. Use of triptans in combination with ASA or acetaminophen, or using alternative modes of administration such as injectables, may be associated with slightly better outcomes than standard dose triptan tablets.

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Tài liệu tham khảo

World Health OrganizationFactsheet No. 277: Headache Disorders(Available at:http://www.who.int/mediacentre/factsheets/fs277/en/). October2012(Accessed July 17 2014).

Using the Triptans to Treat: Migraine Headaches. Comparing Effectiveness Safety and Price: Consumer Reports Best Buy Drugs. March2013.

10.1017/S0317167100118943

NICE.Headaches: Diagnosis and Management of Headaches in Young People and Adults (Clinical guideline 150: Methods Evidence and Recommendations): National Institute for Health and Clinical Excellence 2012. September2012.

Sumamo SchellenbergE DrydenDM PasichnykD et al.Acute Migraine Treatment in Emergency Settings [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US);2012Nov. (Comparative Effectiveness Reviews No. 84.) Available at:http://www.ncbi.nlm.nih.gov/books/NBK115368/

10.1017/S0266462312000517

10.1046/j.1468-2982.2001.00169.x

10.1016/S0140-6736(01)06711-3

10.2165/11537990-000000000-00000

10.1177/0333102413508661

10.1136/bmj.d5928

10.1016/j.jclinepi.2009.06.006

10.1016/j.jclinepi.2009.06.005

10.1177/0272989X12458724

10.1093/ije/dys041

10.1002/sim.3594

DiasS SuttonA WeltonN et al.NICE DSU Technical Support Document 2: Generalised Linear Modelling Framework for Pairwise and Network Meta‐Analysis of Randomised Controlled Trials. May2011[cited 2012 June 13]: Available at:http://www.nicedsu.org.uk/TSD6%20Software.final.08.05.12.pdf.

10.1023/A:1008929526011

10.1258/jhsrp.2008.008020

10.1177/0272989X12455847

10.1177/0333102413485658

Headache Classification Committee of the International Headache Society, 1988, Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain, Cephalalgia, 8, 1

10.1111/j.1526-4610.2008.01121.x

10.1136/jnnp.2003.031286

10.1111/j.1600-0404.2006.00739.x

10.1046/j.1468-1331.2001.00218.x

10.1111/j.1742-1241.2007.01458.x

10.1111/j.1368-5031.2004.00295.x

10.1111/j.1468-2982.2007.01313.x

10.1097/AOG.0b013e3181a98e4d

10.1016/S0029-7844(03)00659-8

CoyleD LeeK SabarreK.Triptans for Migraine Therapy: A Pharmacoeconomic Analysis.2014. [Internet] Ontario Drug Policy Research Network. Available at:http://odprn.ca/wp‐content/uploads/2014/08/Triptan‐PharmacoEcon‐Report‐CENSORED‐for‐review.pdf

National Institute for Health and Clinical Excellence.Diagnosis and management of headaches in young people and adults. Clinical Guideline 150. September2012. [Internet]. National Clinical Guideline Centre at The Royal College of Physicians London. Available at:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0078140/pdf/TOC.pdf

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Headache

Tập 55 Số S4

221-235

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