| Background and objectives:Migraine is a common, chronic neurovascular disorder, the recurrences have a significant impact on patients'quality of life. As pathogenesis remains uncertain, there is no way to cure it. The primary purpose of acute treatment is to terminate the pain, drugs for migraine attacks include both specific and non specific drugs. Ergots, triptans and calcitonin gene-related peptide (CGRP) receptor antagonist are specific acute treatment drugs. Three kinds of drugs have their own features. The aim of this article was to assess the efficacy and safety of three kinds of drugs in treating acute migraine attacks by a meta-analysis, and provide a foundation for clinical practice.Materials and methods:Databases, including Medline(1995.1-2010.6), Pubmed (1995.1-2010.6), Cochrane, CALIS (1999.1-2010.6) and SAGE (2000.1-2010.6) foreign periodicals net, CNKI (1995.1-2010.6) were searched for randomized controlled trials. In accordance with the inclusion and exclusion criteria to retrieve publications, assessed the quality of publications and extracted data. Meta-analyses were performed for the included studies using RevMan 5.0.21 software. Use funnel plot to analyze publication bias.Results:1. Triptans:A total of 127 articles were searched out and 56 of them were enrolled in present meta-analysis. The results of Meta-analysis showed:The efficacy at 2 hours and sustained efficacy at 24 hours in rizatriptan 1 Omg and pain relief rate at 2 hours in 5mg were significantly higher than that in placebo. All 3 dose of eletriptan (20mg,40mg, and 80mg) had higher efficacy than placebo.Sumatriptan50mg, 100mg orally disintegrating tablet and 50mg tablet were more effective than placebo, 100mg tablet was more effective than placebo except sustained pain relief rate at 24 hours. Almotriptan12.5mg was more effective than placebo, in 6.25mg and 25mg, pain relief rate after 2 hours were significantly higher than that in placebo. Zolmitriptan2.5mg and 5mg were more effective than placebo. In both frovatriptan2.5mg and naratriptan2.5mg, the efficacy at 2 hours were significantly higher than that in placebo. In almotriptan, eletriptan, naratriptan, zolmitriptan 2.5mg and lOmg tablet,spray sumatriptan 5mg and 10mg, the incidence rate of adverse effects were similar to placebo.2. The CGRP receptor antagonist:A total of 16 articles were searched out and 4 of them were enrolled in present meta-analysis. The pain-free rate (OR:31.11,95%CI:3.80-254.98, p=0.001) and pain relief rate (OR:5.21, 95%CI:1.91-14.22,p=0.001) after 2 hours in olcegepant2.5mg were significantly higher than that in placebo. In both telcagepant300mg and telcagepant150mg, the pain-free rate and pain relief rate after 2 hours, the sustained pain relief rate and sustained pain free rate at 24 hours in telcagepant300mg and telcagepant150mg were significantly higher than that in placebo. The side effect rates were not significantly increased in olcegepant2.5mg, telcagepant150mg and telcagepant300mg.3. One research compared the efficacy and tolerability of inhaled Dihydroergotamine mesylate (DHE)-MAP004 with placebo. The pain relief rate (OR:5.97,95%CI:1.52,23.43, P=0.01) and pain-free rate (OR:11.00, 95%CI:1.26,96.21, P=0.03) after 2 hours in MAP004 0.5mg were significantly higher than that in placebo. In MAP004 lmg, the pain-free rate and pain relief rate after 2 hours were significantly higher than that in placebo. The sustained pain relief rate and sustained pain free rate at 24 hours were similar with placebo. The side effect rates were not significantly increased in MAP0040.5mg and 1mg.Conclusions:1. All the efficacy indicators showed there were higher treatment response rate in rizatriptanlOmg, eletriptan20mg,40mg,80mg, sumatriptan50mg, 100mg ODT,50mg tablets, almotriptan12.5mg, zolmitriptan2.5mg,5mg compared with placebo. Some of values show higher efficacy in rizatriptan5mg, sumatriptan100mg tablets, almotriptan6.25mg,25mg, frovatriptan2.5mg, naratriptan2.5mg. Almotriptan, eletriptan, naratriptan, zolmitriptan2.5mg, lOmg tablets, sumatriptan5mg, 10mg spray were all well tolerated. Eletriptan may be a better choice in treating migraine.2. The CGRP receptor antagonists were effective and well tolerated for migraine treatment.3. MAP0004 was effective and well tolerated in treating migraine. |
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