European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention—part 2: flunarizine

The Journal of Headache and Pain

Review

Dena Zeraatkar¹  Muizz Hussain¹  Simona Sacco²  Raffaele Ornello²  Tessa de Vries³  Antoinette MaassenVanDenBrink³  Christian Lampl⁴  Christina I. Deligianni⁵  Uwe Reuter⁶  Margarita Sanchez-del-Rio⁷  Esme Ekizoglu⁸  Derya Uluduz⁹  Jan Versijpt^1,10  Raquel Gil-Gouveia^1,11 

[1] Department of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada;Department of Biotechnological and Applied Clinical Sciences, University of L´Aquila, L´Aquila, Italy;Department of Internal Medicine, Erasmus MC Medical Center, Rotterdam, The Netherlands;Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria;Headache Medical Center Linz, Linz, Austria;Department of Neurology, Athens Naval Hospital, Athens, Greece;Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany and Universitätsmedizin Greifswald, Greifswald, Germany;Department of Neurology, Clinica Universidad de Navarra, Madrid, Spain;Department of Neurology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey;Department of Neurology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey;Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium;Neurology Department, Hospital da Luz Headache Center, Hospital da Luz Lisboa, Lisbon, Portugal;Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal;

关键词: Migraine;    Prophylactic treatment;    Flunarizine;    Meta-analysis;   

DOI  :  10.1186/s10194-023-01657-3

 received in 2023-07-06, accepted in 2023-08-21,  发布年份 2023

来源: Springer

【 摘 要 】

ObjectiveNovel disease-specific and mechanism-based treatments sharing good evidence of efficacy for migraine have been recently marketed. However, reimbursement by insurers depends on treatment failure with classic anti-migraine drugs. In this systematic review and meta-analysis, we aimed to identify and rate the evidence for efficacy of flunarizine, a repurposed, first- or second-line treatment for migraine prophylaxis.MethodsA systematic search in MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov was performed for trials of pharmacological treatment in migraine prophylaxis, following the Preferred Reporting Items for Systematic Reviews (PRISMA). Eligible trials for meta-analysis were randomized, placebo–controlled studies comparing flunarizine with placebo. Outcomes of interest according to the Outcome Set for preventive intervention trials in chronic and episodic migraine (COSMIG) were the proportion of patients reaching a 50% or more reduction in monthly migraine days, the change in monthly migraine days (MMDs), and Adverse Events (AEs) leading to discontinuation.ResultsFive trials were eligible for narrative description and three for data synthesis and analysis. No studies reported the predefined outcomes, but one study assessed the 50% reduction in monthly migraine attacks with flunarizine as compared to placebo showing a benefit from flunarizine with a low or probably low risk of bias. We found that flunarizine may increase the proportion of patients who discontinue due to adverse events compared to placebo (risk difference: 0.02; 95% CI -0.03 to 0.06).ConclusionsPublished flunarizine trials predate the recommended endpoints for evaluating migraine prophylaxis drugs, hence the lack of an adequate assessment for these endpoints. Further, modern-day, large‐scale studies would be valuable in re-evaluating the efficacy of flunarizine for the treatment of migraines, offering additional insights into its potential benefits.

【 授权许可】

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

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