Network Meta-analysis of Different Treatments for Vestibular Migraine.

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY
CNS drugs Pub Date : 2023-09-01 Epub Date: 2023-09-07 DOI:10.1007/s40263-023-01037-0
Jiann-Jy Chen, Bing-Syuan Zeng, Kuan-Pin Su, Yi-Cheng Wu, Yu-Kang Tu, Brendon Stubbs, Tien-Yu Chen, Bing-Yan Zeng, Yen-Wen Chen, Chih-Wei Hsu, Ping-Tao Tseng
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引用次数: 0

Abstract

Introduction: Although one of the major presentations of vestibular migraine is dizziness with/without unsteady gait, it is still classified as one of the migraine categories. However, in contrast to ordinary migraine, vestibular migraine patients have distinct characteristics, and the detailed treatment strategy for vestibular migraine is different and more challenging than ordinary migraine treatment. Currently, there is no conclusive evidence regarding its management, including vestibular migraine prophylaxis.

Aim: The objective of this current network meta-analysis (NMA) was to compare the efficacy and acceptability of individual treatment strategies in patients with vestibular migraine.

Methods: The PubMed, Embase, ScienceDirect, ProQuest, Web of Science, ClinicalKey, Cochrane Central, and ClinicalTrials.gov databases were systematically searched for randomized controlled trials (RCTs), with a final literature search date of 30 December 2022. Patients diagnosed with vestibular migraine were included. The PICO of the current study included (1) patients with vestibular migraine; (2) intervention: any active pharmacologic or non-pharmacologic intervention; (3) comparator: placebo-control, active control, or waiting list; and (4) outcome: changes in migraine frequency or severity. This NMA of RCTs of vestibular migraine treatment was conducted using a frequentist model. We arranged inconsistency and similarity tests to re-examine the assumption of NMA, and also conducted a subgroup analysis focusing on RCTs of pharmacological treatment for vestibular migraine management. The primary outcome was changes in the frequency of vestibular migraines, while the secondary outcomes were changes in vestibular migraine severity and acceptability. Acceptability was set as the dropout rate, which was defined as the participant leaving the study before the end of the trial for any reason. Two authors independently evaluated the risk of bias for each domain using the Cochrane risk-of-bias tool.

Results: Seven randomized controlled trials (N = 828, mean age 37.6 years, 78.4% female) and seven active regimens were included. We determined that only valproic acid (standardized mean difference [SMD] -1.61, 95% confidence interval [CI] -2.69, -0.54), propranolol (SMD -1.36, 95% CI -2.55, -0.17), and venlafaxine (SMD -1.25, 95% CI -2.32, -0.18) were significantly associated with better improvement in vestibular migraine frequency than the placebo/control groups. Furthermore, among all the investigated pharmacologic/non-pharmacologic treatments, valproic acid yielded the greatest decrease in vestibular migraine frequency among all the interventions. In addition, most pharmacologic/non-pharmacologic treatments were associated with similar acceptability (i.e. dropout rate) as those of the placebo/control groups.

Conclusions: The current study provides evidence that only valproic acid, propranolol, and venlafaxine might be associated with beneficial efficacy in vestibular migraine treatment.

Trial registration: CRD42023388343.

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前庭偏头痛不同治疗方法的网络荟萃分析。
引言:尽管前庭偏头痛的主要表现之一是伴有/不伴有步态不稳的头晕,但它仍然被归类为偏头痛的一类。然而,与普通偏头痛相比,前庭偏头痛患者具有明显的特征,前庭偏头痛的详细治疗策略与普通偏头痛治疗不同,也更具挑战性。目前,还没有关于其治疗的确凿证据,包括前庭偏头痛的预防。目的:当前网络荟萃分析(NMA)的目的是比较前庭偏头痛患者个体治疗策略的疗效和可接受性。方法:系统检索PubMed、Embase、ScienceDirect、ProQuest、Web of Science、ClinicalKey、Cochrane Central和ClinicalTrials.gov数据库中的随机对照试验(RCT),最终文献检索日期为2022年12月30日。包括被诊断为前庭性偏头痛的患者。本研究的PICO包括(1)前庭性偏头痛患者;(2) 干预:任何有效的药物或非药物干预;(3) 对照组:安慰剂对照组、主动对照组或等待名单;和(4)结果:偏头痛频率或严重程度的变化。前庭偏头痛治疗的随机对照试验的NMA是使用频率学家模型进行的。我们安排了不一致性和相似性测试来重新检查NMA的假设,并进行了一项亚组分析,重点是前庭偏头痛药物治疗的随机对照试验。主要结果是前庭偏头痛频率的变化,而次要结果是前庭头痛严重程度和可接受性的变化。可接受性被设定为辍学率,辍学率被定义为参与者在试验结束前因任何原因离开研究。两位作者使用Cochrane偏倚风险工具独立评估了每个领域的偏倚风险。结果:纳入了7项随机对照试验(N=828,平均年龄37.6岁,78.4%为女性)和7种有效方案。我们确定,与安慰剂/对照组相比,只有丙戊酸(标准化平均差[SMD]-1.61,95%置信区间[CI]-2.69,-0.54)、普萘洛尔(SMD-1.36,95%CI-2.55,-0.17)和文拉法辛(SMD-2.25,95%CI-1.32,-0.18)与前庭偏头痛频率的改善显著相关。此外,在所有研究的药物/非药物治疗中,丙戊酸在所有干预措施中使前庭偏头痛频率下降幅度最大。此外,大多数药物/非药物治疗与安慰剂/对照组的可接受性(即脱落率)相似。结论:目前的研究提供的证据表明,只有丙戊酸、普萘洛尔和文拉法辛可能与前庭偏头痛的有益疗效有关。试用注册号:CRD42023388343。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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