心血管疾病高风险患者服用曲坦类药物的安全性：目标试验模拟

IF 6.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Mayo Clinic proceedings Pub Date : 2024-11-01 DOI:10.1016/j.mayocp.2024.03.023

Zhen Wang PhD , Juliana H. VanderPluym MD , Rashmi B. Halker Singh MD , Reem A. Alsibai MD , Daniel L. Roellinger BS , Mohammed Firwana MBBS , Mohammad Hassan Murad MD, MPH

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引用次数: 0

摘要

目的：评估三苯氧胺对患有心血管疾病或心血管风险较高的偏头痛患者的安全性：评估三苯氧胺对患有心血管疾病或心血管风险升高的偏头痛患者的安全性：我们从美国的一个多州医疗系统（2000 年 1 月至 2022 年 8 月）中检索了患有偏头痛、确诊心血管/脑血管疾病或至少有两种心血管风险因素的成人患者的数据。我们比较了三苯氧胺和非三苯氧胺治疗对开始治疗 60 天内主要不良心血管事件 (MACE) 及其组成部分的影响。我们模仿了一项目标试验，并采用倾向得分匹配法进行分析：三普类药物组的 3518 名患者与非三普类药物组的 3518 名患者（中位年龄 55 岁；80.60% 为女性）进行了匹配。60天后，三普类药物组有52名患者（1.48%）出现MACE，而非三普类药物组有13名患者（0.37%）出现MACE（相对风险[RR]，4.00；95% CI，2.24至7.14）。接受三苯氧胺治疗的患者发生非致命性心肌梗死（15 例患者（0.43%）与 0 例患者（0.00%））、心力衰竭（RR，4.50；95% CI，1.91 至 10.61）和非致命性中风（RR，8.00；95% CI，1.00 至 63.96）的风险也明显更高。每组各有五名患者（0.14%）死亡。当分析对象仅限于舒马曲坦、口服曲坦类药物、慢性偏头痛患者、心血管疾病史或脑血管疾病史时，结果是一致的：结论：曲普坦类药物可能会增加MACE的风险；然而，在患有心血管疾病或心血管风险升高的偏头痛患者中，MACE的发生率仍然很低：Clinicaltrials: gov Identifier：NCT05854992 (https://classic.Clinicaltrials: gov/ct2/show/NCT05854992)。

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Safety of Triptans in Patients Who Have or Are at High Risk for Cardiovascular Disease

Objective

To evaluate the safety of triptans in migraine patients with cardiovascular disease or elevated cardiovascular risk.

Patients and Methods

We retrieved data from a multistate US-based health system (January 2000 to August 2022) on adults with migraine and confirmed cardiovascular/cerebrovascular disease, or at least two cardiovascular risk factors. We compared the effect of triptans to nontriptan treatments on major adverse cardiovascular events (MACE) and its components at 60 days of starting treatments. We emulated a target trial and used propensity score matching for analysis.

Results

The 3518 patients in the triptan group were matched to the 3518 patients in the nontriptan group (median age, 55 years; 80.60% female). At 60 days, 52 patients (1.48%) in the triptan group had MACE, compared with 13 patients (0.37%) in the nontriptan group (relative risk [RR], 4.00; 95% CI, 2.24 to 7.14). Patients treated with triptans also had significantly higher risk of nonfatal myocardial infarction (15 patients (0.43%) vs 0 patients (0.00%)); heart failure (RR, 4.50; 95% CI, 1.91 to 10.61); and nonfatal stroke (RR, 8.00; 95% CI, 1.00 to 63.96). Five patients (0.14%) in each group died. The findings were consistent when analyses were restricted to sumatriptan, oral administration of triptan, patients with chronic migraine, history of cardiovascular disease, or history of cerebrovascular disease.

Conclusion

Triptans likely increase the risk of MACE; however, the incidence of MACE remains low in migraine patients with cardiovascular disease or elevated cardiovascular risk.

Trial Registration

Treatments of Migraine With Triptans in Individuals With Elevated Cardiovascular Risk and in Pregnant Women. ClinicalTrials.gov Identifier: NCT05854992 (https://classic.clinicaltrials.gov/ct2/show/NCT05854992)

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来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

期刊介绍： Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.