| Objective:In 2014,the U.S.Food and Drug Administration classified the Most Bothersome Symptom of migraine as nausea,vomiting,photophobia,and phonophobia.For some migraineurs,MBS is more significant than the impact of migraine attacks on the patient’s normal life.Based on the existing evidence of randomized controlled clinical trials on CGRP receptor antagonists in the treatment of acute migraine MBS,this study conducted a systematic review and meta-analysis,in order to provide evidence-based evidence for the treatment of acute migraine MBS.Methods:Through computer search Pub Med,Web of Science,Embase,the Cochrane Library,China National Knowledge Infrastructure,Wan Fang Data,China Science and Technology Journal Database and other authoritative databases,we collected the randomized clinical trials(RCTS)about CGRP receptor antagonists for the most troubling symptoms in the acute phase of migraine from the time the database was established to March 1,2023.The English database search is(" most bothersome symptom " OR " most bothersome migraine-associated symptom" OR " MBS ")AND "migraine".Chinese database search terms include "most annoying symptoms","migraine",etc.(no language restrictions).Meta-analysis was performed using Rev Man 5.4,R language 4.3.0 and Stata 12.0 software.Results:A total of 8 studies were included in this meta-analysis,including three small-molecule CGRP receptor antagonists(Ubrogepant,Rimegepant,Zavegepant)and a CGRP monoclonal antibody(Eptinezumab),involving 11,222 participants with an average age of 41 and 86.4 percent female.5555 participants participated in the CGRP receptor antagonist group and 5667 participants in the placebo group.1 Baseline levels of nausea,photophobia,and phonophobia associated with migraine: 67% of migraineurs had nausea(95% CI: 62%--72%);Photophobia was associated with 93% of migraineurs(95%CI: 89%-97%);Phonophobia s symptoms were associated with 81% of migraineurs(95% CI: 80%-83%).24%of patients thought nausea was MBS(95% CI: 21%--26%);56% of patients thought photophobia was MBS(95% CI: 53%-58%);24% of patients thought phonophobia was MBS(95% CI: 18%-22%).2 Efficacy of CGRP receptor antagonist in the treatment of two hours MBS in the phase of migraine: In terms of overall efficacy,the efficacy of CGRP receptor antagonists(both small-molecule CGRP receptor antagonists and CGRP monoclonal antibodies)was superior to that of placebo group(OR=1.54,95%CI:1.42-1.66).3 Subgroup analysis of the efficacy of CGRP receptor antagonist in the treatment of two hours MBS in the phase of migraine: Grouping according to different drug types,the results showed that there was no statistical difference between Ubrogepant group,Rimegepant group and Zavegepant group(P=0.12).CGRP monoclonal antibody(OR=2.23,95%CI: 1.54-3.22)was superior to Ubrogepant group(OR=1.56,95%CI: 1.36-1.80)or Rimegepant group(OR=1.57,95%CI: 1.36-1.82)or Zavegepant group(OR=1.40;95%CI: 1.23-1.61).Groups were divided according to different administration methods,and the results showed that there was no statistical difference between the oral group and the nasal spray group(P=0.05).Intravenous administration(OR=2.23,95% CI: 1.54-3.22)was superior to oral administration(OR=1.57,95% CI: 1.42-1.74)or nasal spray(OR=2.23,95%CI: 1.23-1.61).Conclusions:Photophobia,nausea and phonophobia have high incidence in acute phase of migraine.MBS contains photophobia,nausea,and phonophobia that are not associated with migraines.The efficacy of CGRP receptor antagonist in the treatment of acute migraine MBS was significant,and there was no significant correlation with the administration method and drug type.Intravenous CGRP monoclonal antibodies may be more effective. |
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