CGRP-antibodies, topiramate and botulinum toxin type A in episodic and chronic migraine: A systematic review and meta-analysis.
Migraine disorders
efficacy
outcome
prevention
responder rate
treatment
Journal
Cephalalgia : an international journal of headache
ISSN: 1468-2982
Titre abrégé: Cephalalgia
Pays: England
ID NLM: 8200710
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
pubmed:
17
6
2021
medline:
18
1
2022
entrez:
16
6
2021
Statut:
ppublish
Résumé
The approval of monoclonal antibodies for prevention of migraine has revolutionized treatment for patients. Oral preventatives are still considered first line treatments as head-to-head trials comparing them with antibodies are lacking. The main purpose of this study was to provide a comparative overview of the efficacy of three commonly prescribed migraine preventative medication classes. For this systematic review and meta-analysis, we searched the databases CENTRAL, EMBASE, and MEDLINE until 20 March 2020. We included RCTs reporting the 50% response rates for topiramate, Botulinum Toxin Type A and monoclonal antibodies against CGRP(r). Studies were excluded if response rates were not reported, treatment allocation was unclear, or if study quality was insufficient. Primary outcome measure were the 50% response rates. The pooled odds ratios with 95% confidence intervals were calculated with the random effects model. The study was registered at PROSPERO (CRD42020222880). We identified 6552 reports. Thirty-two were eligible for our review. Studies assessing monoclonal antibodies included 13,302 patients and yielded pooled odds ratios for the 50% response rate of 2.30 (CI: 2.11-2.50). Topiramate had an overall effect estimate of 2.70 (CI: 1.97-3.69) with 1989 included patients and Botulinum Toxin Type A achieved 1.28 (CI: 0.98-1. 67) with 2472 patients included. Topiramate, botulinum toxin type A and monoclonal antibodies showed higher odds ratios in achieving a 50% response rate compared to placebo. Topiramate numerically demonstrated the greatest effect size but also the highest drop-out rate.
Sections du résumé
BACKGROUND
The approval of monoclonal antibodies for prevention of migraine has revolutionized treatment for patients. Oral preventatives are still considered first line treatments as head-to-head trials comparing them with antibodies are lacking.
METHODS
The main purpose of this study was to provide a comparative overview of the efficacy of three commonly prescribed migraine preventative medication classes. For this systematic review and meta-analysis, we searched the databases CENTRAL, EMBASE, and MEDLINE until 20 March 2020. We included RCTs reporting the 50% response rates for topiramate, Botulinum Toxin Type A and monoclonal antibodies against CGRP(r). Studies were excluded if response rates were not reported, treatment allocation was unclear, or if study quality was insufficient. Primary outcome measure were the 50% response rates. The pooled odds ratios with 95% confidence intervals were calculated with the random effects model. The study was registered at PROSPERO (CRD42020222880).
FINDINGS
We identified 6552 reports. Thirty-two were eligible for our review. Studies assessing monoclonal antibodies included 13,302 patients and yielded pooled odds ratios for the 50% response rate of 2.30 (CI: 2.11-2.50). Topiramate had an overall effect estimate of 2.70 (CI: 1.97-3.69) with 1989 included patients and Botulinum Toxin Type A achieved 1.28 (CI: 0.98-1. 67) with 2472 patients included.
INTERPRETATION
Topiramate, botulinum toxin type A and monoclonal antibodies showed higher odds ratios in achieving a 50% response rate compared to placebo. Topiramate numerically demonstrated the greatest effect size but also the highest drop-out rate.
Identifiants
pubmed: 34130525
doi: 10.1177/03331024211018137
pmc: PMC8506070
doi:
Substances chimiques
Antibodies, Monoclonal
0
Topiramate
0H73WJJ391
Botulinum Toxins, Type A
EC 3.4.24.69
Calcitonin Gene-Related Peptide
JHB2QIZ69Z
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1222-1239Références
Stat Med. 2002 Jun 15;21(11):1539-58
pubmed: 12111919
J Headache Pain. 2020 Dec 2;21(1):137
pubmed: 33267788
Cephalalgia. 2003 Oct;23(8):820-4
pubmed: 14510929
PLoS Med. 2009 Jul 21;6(7):e1000100
pubmed: 19621070
Control Clin Trials. 1996 Feb;17(1):1-12
pubmed: 8721797
JAMA. 2004 Feb 25;291(8):965-73
pubmed: 14982912
Eur Neurol. 1994;34 Suppl 2:6-11
pubmed: 7835383
Headache. 2008 Feb;48(2):201-9
pubmed: 18042229
Lancet Neurol. 2017 Jun;16(6):425-434
pubmed: 28460892
Headache. 2000 Jun;40(6):445-50
pubmed: 10849039
Cephalalgia. 2018 Jan;38(1):1-211
pubmed: 29368949
Headache. 2019 Nov;59(10):1731-1742
pubmed: 31612482
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
N Engl J Med. 2017 Nov 30;377(22):2123-2132
pubmed: 29171821
Lancet. 2018 Nov 24;392(10161):2280-2287
pubmed: 30360965
J Neurol. 2004 Aug;251(8):943-50
pubmed: 15316798
Cephalalgia. 2018 Jul;38(8):1442-1454
pubmed: 29848108
Headache. 2012 Jun;52(6):930-45
pubmed: 22671714
Neurology. 2003 Feb 11;60(3):441-8
pubmed: 12578925
Neurol Sci. 2004 Dec;25(5):245-50
pubmed: 15624081
Rev Neurol (Paris). 2020 Dec;176(10):788-803
pubmed: 32758365
Neurology. 2018 Dec 11;91(24):e2211-e2221
pubmed: 30446596
Lancet Neurol. 2020 Oct;19(10):814-825
pubmed: 32949542
Cephalalgia. 2020 Mar;40(3):241-254
pubmed: 32075406
Headache. 2015 Jan;55(1):21-34
pubmed: 25600719
Headache. 2011 Oct;51(9):1358-73
pubmed: 21883197
J Headache Pain. 2019 Jan 16;20(1):6
pubmed: 30651064
Lancet Neurol. 2014 Nov;13(11):1100-1107
pubmed: 25297013
Neurol Sci. 2004 Oct;25 Suppl 3:S244-5
pubmed: 15549548
Lancet Neurol. 2016 Apr;15(4):382-90
pubmed: 26879279
JAMA Neurol. 2018 Sep 1;75(9):1080-1088
pubmed: 29813147
Cephalalgia. 2007 Jun;27(6):492-503
pubmed: 17428299
Brain Behav. 2018 Jun;8(6):e00950
pubmed: 30106228
N Engl J Med. 2017 Nov 30;377(22):2113-2122
pubmed: 29171818
Neurology. 2020 Mar 31;94(13):e1365-e1377
pubmed: 32209650
Lancet Neurol. 2015 Nov;14(11):1081-90
pubmed: 26432182
JAMA. 1996 Aug 28;276(8):637-9
pubmed: 8773637
Headache. 2007 Apr;47(4):486-99
pubmed: 17445098
Clin Neuropharmacol. 2006 Sep-Oct;29(5):269-75
pubmed: 16960472
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
Clin Ther. 2006 Jul;28(7):1002-11
pubmed: 16990078
Cephalalgia. 2015 May;35(6):478-88
pubmed: 25164920
JAMA. 2018 May 15;319(19):1999-2008
pubmed: 29800211
Cephalalgia. 2019 Aug;39(9):1075-1085
pubmed: 31234642
Lancet Neurol. 2015 Nov;14(11):1091-100
pubmed: 26432181
Res Synth Methods. 2017 Dec;8(4):537-553
pubmed: 28801932
J Headache Pain. 2015;16:531
pubmed: 25990699
Cephalalgia. 2004 Oct;24(10):838-43
pubmed: 15377314
Headache. 2001 Nov-Dec;41(10):968-75
pubmed: 11903524
Cephalalgia. 2018 May;38(6):1026-1037
pubmed: 29471679
JAMA Neurol. 2018 Feb 1;75(2):187-193
pubmed: 29255900
Neurol Clin. 1997 Feb;15(1):1-13
pubmed: 9058393
Lancet. 2019 Sep 21;394(10203):1030-1040
pubmed: 31427046
Nat Rev Neurol. 2018 Jun;14(6):338-350
pubmed: 29691490