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.

中文翻译：

---

发作性和慢性偏头痛中的 CGRP 抗体、托吡酯和 A 型肉毒杆菌毒素：系统评价和荟萃分析

背景

用于预防偏头痛的单克隆抗体的批准彻底改变了患者的治疗方法。口服预防剂仍然被认为是一线治疗，因为缺乏将它们与抗体进行比较的头对头试验。

方法

本研究的主要目的是对三种常用的偏头痛预防药物类别的疗效进行比较概述。对于这项系统评价和荟萃分析，我们搜索了数据库 CENTRAL、EMBASE 和 MEDLINE，直到 2020 年 3 月 20 日。我们纳入了报告托吡酯、A 型肉毒杆菌毒素和针对 CGRP(r) 的单克隆抗体的 50% 反应率的随机对照试验。如果未报告反应率、治疗分配不明确或研究质量不足，则排除研究。主要结果测量是 50% 的反应率。使用随机效应模型计算具有 95% 置信区间的汇总优势比。该研究在 PROSPERO (CRD42020222880) 注册。

发现

我们确定了 6552 份报告。32 人符合我们的审查条件。评估单克隆抗体的研究包括 13,302 名患者，得出 50% 反应率为 2.30（CI：2.11-2.50）的汇总优势比。托吡酯的总体效果估计值为 2.70（CI：1.97-3.69），包括 1989 名患者，A 型肉毒杆菌毒素达到 1.28（CI：0.98-1. 67），包括 2472 名患者。

解释

与安慰剂相比，托吡酯、A 型肉毒杆菌毒素和单克隆抗体在达到 50% 的反应率方面显示出更高的优势比。托吡酯在数字上显示出最大的效果大小，但也有最高的辍学率。