目的:为了比较与使用lasmiditan相关的结果,rimegepant,ubrogepant,和zavegepant用于偏头痛的急性治疗。
方法:我们检索了从数据库开始到2023年8月31日的四个电子数据库,以确定报告偏头痛急性治疗有效性和安全性的随机对照试验(RCT)。根据Cochrane工具评估纳入的随机对照试验的偏倚风险,以及使用CINeMA方法的证据确定性。我们进行了频繁的网络荟萃分析(NMA)来总结证据。使用R-4.3.1分析数据。
结果:共纳入18项符合条件的研究,包括10项不同类型的干预措施,对22,429名偏头痛患者进行干预。NMA结果表明,与usrogepant(25mg和50mg)和zavegepant相比,lasmiditan(100mg和200mg)在2小时间隔内实现疼痛缓解的可能性增加。同样,相对于Zavegepant,rimegepant(75mg)和ugrogepant(50mg和100mg)显示出在24小时内维持疼痛缓解的可能性增加。此外,与usrogepant(25毫克)和lasmiditan(50毫克)相比,rimegepant(75mg)在2小时内获得免于畏光的可能性增加。关于安全性,Lasmiditan的不良事件风险最高,这与不良反应的发生率增加有关,包括头晕,嗜睡,虚弱,感觉异常,和疲劳。
结论:在此NMA中,从非常低到高的一系列证据强调了75毫克和100毫克乌布罗的良好疗效和耐受性,将他们定位为偏头痛急性治疗的潜在候选人。同时,lasmiditan(100毫克和200毫克)表现出显著的疗效,尽管伴随着对不良事件的易感性增加。这些发现仍然应该谨慎对待,主要是由于与间接比较相关的内在限制。
OBJECTIVE: To compare the outcomes associated with the use of
lasmiditan, rimegepant, ubrogepant, and zavegepant for the acute management of migraine headaches.
METHODS: We searched four electronic databases from database inception to August 31, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the acute treatment of migraine. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of evidence using the CINeMA approach. We conducted frequentist network meta-analyses (NMA) to summarise the evidence. Data were analyzed using R-4.3.1.
RESULTS: A total of 18 eligible studies including 10 different types of interventions with 22,429 migraine patients were included. NMA results showed that compared to ubrogepant (25 mg and 50 mg) and zavegepant,
lasmiditan (100 mg and 200 mg) exhibits an elevated probability of achieving pain relief within a 2-hour interval. Similarly, relative to zavegepant, rimegepant (75 mg) and ubrogepant (50 mg and 100 mg) demonstrate an enhanced likelihood of sustaining pain relief over a 24-hour period. Furthermore, in contrast to ubrogepant (25 mg) and
lasmiditan (50 mg), rimegepant (75 mg) presents a heightened probability of achieving freedom from photophobia within 2 h. Regarding safety,
lasmiditan carries the highest risk of adverse events, which are associated with an increased incidence of adverse effects, including dizziness, somnolence, asthenia, paresthesia, and fatigue.
CONCLUSIONS: In this NMA, a spectrum of evidence ranging from very low to high levels underscores the favorable efficacy and tolerability of rimegepant 75 mg and ubrogepant 100 mg, positioning them as potential candidates for the acute management of migraine. Concurrently,
lasmiditan (100 mg and 200 mg) exhibits notable efficacy, albeit accompanied by an increased susceptibility to adverse events. These findings should still be approached with caution, primarily due to the intrinsic limitations associated with indirect comparisons.