目的:本系统评价和荟萃分析的目的是确定发作性偏头痛(EM)或慢性偏头痛(CM)患者,用抗CGRP抗体治疗的人,显示从基线时的药物过度使用(MO)或药物过度使用头痛(MOH)状态到非过度使用状态的逆转。此外,本研究旨在确定哪些急性头痛药物(AHM)对抗CGRP抗体的反应更有效.
方法:在PubMed数据库中对2013年1月至2023年9月的相关研究进行了系统搜索。我们纳入了三期随机对照试验,以检查抗CGRP抗体在EM或CM患者中的作用及其MO状态。进行了荟萃分析,以发现抗CGRP抗体与基线时MO或MOH恢复为非MO状态或低于MOH阈值的EM和CM患者数量之间的关联。
结果:最初的搜索共产生了345项研究。删除重复项并按照纳入标准进行筛选后,5项研究满足了我们的条件。每一项研究都回顾了接受抗CGRP抗体后患者对MO状态变化的反应,包括eptinezumab,fremanezumab,galcanezumab,和erenumab,与安慰剂相比。我们的研究分析了三个AHM类别:曲坦,简单的镇痛药,和多种药物。总相对危险度(RR)为1.44(95%CI,1.31~1.59;p<0.001)。triptans的RR,简单的镇痛药,和多药物组为1.71(95%CI,1.53至1.91;p<0.001),1.10(95%CI,0.83至1.47;p=0.5),和1.29(95CI分别为1.14至1.46;p<0.001)。
结论:荟萃分析表明,除简单镇痛药外,所有纳入研究和所有AHM类别的抗CGRP抗体在从MO或MOH状态过渡到非MO状态或低于MOH阈值(RR=1.44)方面具有统计学意义。曲坦组患者的RR最高,为1.71,p值<0.001,而单纯镇痛药组的RR为1.10,p值>0.05。有趣的是,这一分析可以解释为抗CGRP抗体可能无法有效减少EM或CM患者的简单镇痛药使用.需要进一步的研究来调查这些问题。
OBJECTIVE: The objective of this systematic review and meta-analysis was to determine whether patients with episodic (EM) or chronic migraine (CM), who were treated with anti-CGRP antibodies, showed a reversal from medication overuse (MO) or medication overuse headache (MOH) status at their baseline to non-overuse status. Furthermore, this
study aimed to establish which acute headache medication (AHM) categories responded more effectively to anti-CGRP antibodies.
METHODS: A systematic search was conducted in the PubMed database for relevant studies from January 2013 to September 2023. We included phase three randomized controlled trials to examine the role of anti-CGRP antibodies in patients with EM or CM and their MO status. A meta-analysis was conducted to find the association between anti-CGRP antibodies and the number of EM and CM patients with MO or MOH at baseline that reverted to non-MO status or below the MOH threshold.
RESULTS: The initial search yielded a total of 345 studies. After removing duplicates and screening with inclusion criteria, 5 studies fulfilled our conditions. Each
study reviewed the response to changes in the MO status of patients after receiving anti-CGRP antibodies, including eptinezumab, fremanezumab, galcanezumab, and erenumab, compared to placebo. Our
study analyzed three AHM categories: triptans, simple analgesics, and multiple drugs. The overall relative risk (RR) was 1.44 (95% CI, 1.31 to 1.59; p < 0.001). The RRs for triptans, simple analgesics, and multi-drug groups were 1.71 (95% CI, 1.53 to 1.91; p < 0.001), 1.10 (95% CI, 0.83 to 1.47; p = 0.5), and 1.29 (95%CI 1.14 to 1.46; p < 0.001) respectively.
CONCLUSIONS: The meta-analysis has shown that anti-CGRP antibodies were statistically significant in transitioning from MO or MOH status to non-MO status or below the MOH threshold (RR = 1.44) for all included studies and all AHM categories except for simple analgesics. Patients from the triptan group had the highest RR of 1.71 with a p-value < 0.001, while the simple analgesics group had an RR of 1.10, however, with a p-value > 0.05. Interestingly, this analysis can be interpreted as that anti-CGRP antibodies might not be effective in reducing simple analgesics use in EM or CM patients. Further studies are needed to investigate these matters.