Efficacy and safety of intranasal agents for the acute treatment of migraine: a systematic review and network meta-analysis

The Journal of Headache and Pain

Review

Tiantian Zhu¹  Shaojie Duan²  Lei Liu³  Zunjing Liu⁴  Hui Xia⁵  Ziyao Wang⁵  Guanglu Li⁵  Zhiying Ren⁵ 

[1] Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Department of Geriatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China;Department of Neurology, China-Japan Friendship Hospital, Beijing, China;Department of Neurology, Peking University People’s Hospital, Beijing, China;Graduate School of Beijing, University of Chinese Medicine, Beijing, China;Department of Neurology, China-Japan Friendship Hospital, Beijing, China;

关键词: Migraine;    Acute treatment;    Intranasal agents;    Network meta-analysis;   

DOI  :  10.1186/s10194-023-01662-6

 received in 2023-07-27, accepted in 2023-08-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIntranasal agents may be ideal for the treatment of migraine patients. Many new acute intranasal-specific therapies have been developed, but few of them have been directly compared. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of various intranasal agents for the treatment of acute migraine in adult patients.MethodsThe Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to 15 August 2023. Randomized controlled trials (RCTs) using intranasal agents (no restrictions on dose, formulation, dosing regimen or timing of the first dose) to treat adult patients with acute migraine were included. The primary efficacy endpoint was pain freedom at 2 h, and the primary safety endpoint was adverse events (AEs). The analysis process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsNineteen studies (21 RCTs, 9738 participants) were included. Compared to the placebo, 5 mg of zolmitriptan using a conventional liquid nasal spray device was the most effective for pain freedom at 2 h [odds ratio (OR): 4.67, 95% confidence interval (CI): 3.43 to 6.43] and 24 h (OR: 5.49, 95% CI: 3.58 to 8.42) among all the interventions. Butorphanol nasal spray 1 mg was the most effective (OR: 8.62, 95% CI: 1.11 to 66.92) for pain freedom at 1 h, but with low-quality evidence. DFN-02 presented the highest freedom from nausea (OR: 4.95, 95% CI: 1.29 to 19.01) and phonophobia (OR: 5.36, 95% CI: 1.67 to 17.22) at 2 h, albeit with lower odds of achieving complete pain freedom. ROX-828 showed the highest improvement in freedom from photophobia at 2 h (OR: 4.03, 95% CI: 1.66 to 9.81). Dihydroergotamine nasal spray was significantly associated with the highest risk of AEs (OR: 9.65, 95% CI: 4.39 to 21.22) and was not recommended for routine use. Zavegepant nasal spray demonstrated the lowest risk of AEs (OR: 2.04, 95% CI: 1.37 to 3.03). The results of sensitivity analyses for the primary endpoints (pain freedom at 2 h and AEs) were generally consistent with those of the base case model.ConclusionsCompared with other new intranasal-specific therapies in treating migraine attacks, zolmitriptan nasal spray 5 mg was the most effective agent for pain freedom at 2 h. Zavegepant nasal spray 10 mg had the fewest adverse side effects.

【 授权许可】

CC BY   
© Springer-Verlag Italia S.r.l., part of Springer Nature 2023

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