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The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis

2023-05-19Journal article Open access
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dc.contributor.authorLampl, Christian
dc.contributor.authorMaassen van den Brink, Antoinette
dc.contributor.authorDeligianni, Christina I.
dc.contributor.authorGil-Gouveia, Raquel
dc.contributor.authorJassal, Tanvir
dc.contributor.authorSanchez-Del-Rio, Margarita
dc.contributor.authorReuter, Uwe
dc.contributor.authorUluduz, Derya
dc.contributor.authorVersijpt, Jan
dc.contributor.authorZeraatkar, Dena
dc.contributor.authorSacco, Simona
dc.date.accessioned2023-05-31T08:57:22Z
dc.date.available2023-05-31T08:57:22Z
dc.date.issued2023-05-19
dc.description.abstractOBJECTIVE: While there are several trials that support the efficacy of various drugs for migraine prophylaxis against placebo, there is limited evidence addressing the comparative safety and efficacy of these drugs. We conducted a systematic review and network meta-analysis to facilitate comparison between drugs for migraine prophylaxis. METHODS: We searched MEDLINE, EMBASE, CENTRAL, and clinicaltrials.gov from inception to August 13, 2022, for randomized trials of pharmacological treatments for migraine prophylaxis in adults. Reviewers worked independently and in duplicate to screen references, extract data, and assess risk of bias. We performed a frequentist random-effects network meta-analysis and rated the certainty (quality) of evidence as either high, moderate, low, or very low using the GRADE approach. RESULTS: We identified 74 eligible trials, reporting on 32,990 patients. We found high certainty evidence that monoclonal antibodies acting on the calcitonin gene related peptide or its receptor (CGRP(r)mAbs), gepants, and topiramate increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo. We found moderate certainty evidence that beta-blockers, valproate, and amitriptyline increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, and low certainty evidence that gabapentin may not be different from placebo. We found high certainty evidence that, compared to placebo, valproate and amitriptyline lead to substantial adverse events leading to discontinuation, moderate certainty evidence that topiramate, beta-blockers, and gabapentin increase adverse events leading to discontinuation, and moderate to high certainty evidence that (CGRP(r)mAbs) and gepants do not increase adverse events. CONCLUSIONS: (CGRP(r)mAbs) have the best safety and efficacy profile of all drugs for migraine prophylaxis, followed closely by gepants.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.1186/s10194-023-01594-1pt_PT
dc.identifier.eid85159715329
dc.identifier.issn1129-2369
dc.identifier.pmcPMC10197489
dc.identifier.pmid37208596
dc.identifier.urihttp://hdl.handle.net/10400.14/41257
dc.identifier.wos000991007200001
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectCGRP monoclonal antibodiespt_PT
dc.subjectMigrainept_PT
dc.subjectNetwork meta-analysispt_PT
dc.subjectSystematic reviewpt_PT
dc.titleThe comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue1pt_PT
oaire.citation.titleThe journal of headache and painpt_PT
oaire.citation.volume24pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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