PDF(Pubmed)
Abstract：
Objectives: We compared and ranked the efficacy and tolerability of multiple prophylactic treatments for vestibular migraine (VM), including β-blockers, calcium channel blockers, antiseizure medications, and antidepressants such as tricyclics and serotonin-noradrenaline reuptake inhibitors. Methods: PubMed, Web of Science, Embase, and Cochrane Center for Clinical Trials were systematically searched for relevant randomized clinical trials (RCTs) from March 2023 to May 2023. Studies on the efficacy and tolerability of prophylactic treatments for VM were included. Efficacy was measured using the average vertigo frequency per month and dizziness handicap inventory (DHI) improvement after 3-6 months of treatment. Tolerability was measured by the number of patients reporting at least one adverse event (AE). Network meta-analyses were performed according to a Bayesian framework and a random-effects model based on odds ratios or mean differences (MDs) and 95% confidence intervals (CIs). A sequence of ranking probability was calculated according to the surface under the cumulative ranking (SUCRA) curve. This network meta-analysis was previously registered with PROSPERO (CRD42023422258). Results: Five RCTs comprising 334 patients were analyzed by synthesizing the published evidence. Considering the examined prophylactic therapies, there is significant evidence that valproate acid (VPA) is superior to placebo or abortive treatment alone (MD = -4.12, 95% CI = -8.09, -0.15) in reducing the frequency of vertigo. Flunarizine (MD = 20.00, 95% CI = 10.90, 29.10), valproate acid (MD = 18.88, 95% CI = 10.42, 27.34), and venlafaxine (MD = 11.48, 95% CI = 9.84, 13.12) were significantly more effective than placebo or abortive treatment in reducing DHI. VPA most strongly reduced the frequency of vertigo according to SUCRA, but it ranked third-to-last in tolerability. Flunarizine ranked best in DHI improvement but worst in tolerability. Metoprolol ranked worst for efficacy but best for tolerability. Conclusion: VPA and flunarizine reduced the frequency of vertigo and improved DHI, but they had unfavorable tolerability. The effects of metoprolol on vertigo require further study. Given the low certainty and limited sample, additional head-to-head RCTs are warranted to further confirm efficacy. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier CRD42023422258.
摘要：
目标：我们比较并排名多种预防性治疗对前庭性偏头痛（VM）的疗效和耐受性，包括β受体阻滞剂，钙通道阻滞剂，抗癫痫药物,和抗抑郁药，如三环类药物和5-羟色胺-去甲肾上腺素再摄取抑制剂。方法:PubMed,WebofScience,Embase,从2023年3月至2023年5月,系统搜索了Cochrane临床试验中心的相关随机临床试验(RCT).包括对VM预防性治疗的功效和耐受性的研究。治疗3-6个月后，使用每月平均眩晕频率和头晕障碍量表（DHI）改善来测量疗效。通过报告至少一个不良事件(AE)的患者数量来衡量耐受性。根据贝叶斯框架和基于比值比或平均差（MD）和95％置信区间（CI）的随机效应模型进行网络荟萃分析。根据累积排序(SUCRA)曲线下的表面计算排序概率的序列。该网络荟萃分析先前已在PROSPERO（CRD42023422258）注册。结果：通过综合已发表的证据，分析了五个包含334例患者的RCT。考虑到所检查的预防性治疗，有重要证据表明,丙戊酸(VPA)在减少眩晕发生频率方面优于安慰剂或单独流产治疗(MD=-4.12,95%CI=-8.09,-0.15).氟桂利嗪（MD=20.00，95%CI=10.90，29.10），丙戊酸（MD=18.88，95%CI=10.42，27.34），文拉法辛(MD=11.48,95%CI=9.84,13.12)在降低DHI方面明显优于安慰剂或流产治疗.根据SUCRA，VPA最强烈地降低了眩晕的频率，但它的耐受性排名倒数第三。氟桂利嗪在DHI改善方面排名最高，但耐受性最差。美托洛尔的疗效最差，但耐受性最好。结论：VPA和氟桂利嗪可降低眩晕频率，改善DHI，但是他们有不利的耐受性。美托洛尔对眩晕的作用有待进一步研究。鉴于确定性低和样本有限，需要额外的头对头随机对照试验以进一步确认疗效.系统审查注册：https://www。crd.约克。AC.英国/PROSPERO/；标识符CRD42023422258。
