目的:描述治疗决策过程,并就头痛专家在偏头痛患者治疗决策中考虑的关键因素达成共识,考虑新疗法。
背景:偏头痛疗法长期以来一直受到二元分类的影响,急性与预防性,由于可用药物的限制。可以更灵活地使用的新疗法的出现创造了重新思考这种二元分类的机会。为了确定这些新疗法在治疗中的作用,了解现有指南是否反映临床实践,并就驱动管理的因素达成共识至关重要.
方法:与偏头痛临床专家进行了三轮改良Delphi过程。第一轮由在线问卷组成;第二轮涉及对第一轮汇总结果的在线讨论;第三轮允许参与者修改第一轮答复,纳入第二轮见解。问题引发的可能性评级(0=极不可能100=极有可能),排名,以及对治疗决策的估计。
结果:19位专家完成了三轮Delphi。专家强烈同意“急性”(中位数=100,四分位距[IQR]=5)和“预防”治疗(中位数=90,IQR=15)的定义,但注意到需要为患者定制治疗(中位数=100,IQR=6).专家指出,基于新的急性和预防药物的既定耐受性和疗效,指南的某些方面可能不再适用(中位数=91,IQR=17)。Further,对于具有可靠和可预测的偏头痛触发因素(中位数=100,IQR=10)或具有避免头痛重要的限时期(中位数=100,IQR=12)的患者,专家们就被称为"情境预防"(或"短期预防")的治疗类别达成一致.
结论:使用改进的德尔菲法,一个偏头痛专家小组确定了为偏头痛患者定制治疗方法的重要性和“情境预防”的效用,“考虑到新的治疗方案能够满足这种需求,以及临床识别患者的潜力,以及这种方法将增加价值的时间段。
To characterize treatment decision-making processes and formalize
consensus regarding key factors headache specialists consider in treatment decisions for patients with migraine, considering novel therapies.
Migraine therapies have long been subject to binary classification, acute versus preventive, due to limitations of available drugs. The emergence of novel therapies that can be used more flexibly creates an opportunity to rethink this binary classification. To determine the role of these novel therapies in treatment, it is critical to understand whether existing
guidelines reflect clinical practice and to establish
consensus around factors driving management.
A three-round modified Delphi process was conducted with migraine clinical experts. Round 1 consisted of an online questionnaire; Round 2 involved an online discussion of aggregated Round 1 results; and Round 3 allowed participants to revise Round 1 responses, incorporating Round 2 insights. Questions elicited likelihood ratings (0 = highly unlikely to 100 = highly likely), rankings, and estimates on treatment decision-making.
Nineteen experts completed three Delphi rounds. Experts strongly agreed on definitions for \"acute\" (median = 100, inter-quartile range [IQR] = 5) and \"preventive\" treatment (median = 90, IQR = 15), but noted a need for treatment customization for patients (median = 100, IQR = 6). Experts noted certain aspects of
guidelines may no longer apply based on established tolerability and efficacy of newer acute and preventive agents (median = 91, IQR = 17). Further, experts agreed on a treatment category referred to as \"situational prevention\" (or \"short-term prevention\") for patients with reliable and predictable migraine triggers (median = 100, IQR = 10) or time-limited periods when headache avoidance is important (median = 100, IQR = 12).
Using the modified Delphi method, a panel of migraine experts identified the importance of customizing treatment for people with migraine and the utility of \"situational prevention,\" given the ability of new treatment options to meet this need and the potential to clinically identify patients and time periods when this approach would add value.