Tonabersat For Migraine Prophylaxis:a Systematic Review

Objective:To evaluate the efficacy and tolerability of tonabersat when is used for migraine prevention.Methods:Computerized database search of The Cochrane Pain, Palliative&Supportive Care Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), PubMed, EMbase, ClinicalTrials.gov, ICTRP and CBM. We also searched the ongoing trials. We will not impose any language restrictions. Randomized trials comparing tonabersat with placebo or other drug in prevention of migraine were included. The outcome measures include change in mean number of migraine headache days, change in attacks, responder rates, the reduction of the consumption of rescue medication and adverse events.The quality assessment and clinical relevance criteria utilized were the Cochrane Pain, Palliative&Supportive Care review group criteria as utilized for randomized trials, using RevMan5.2.0to perform a meta-analysis.Result:For this systematic review,133studies were identified. Of these,131studies were excluded, and a total of2studies (after removal of duplicate publication) met inclusion criteria with randomized trial study. Due to differences in outcome measures and the incompleteness of data, it was not possible to perform a meta-analysis of the results. Therefore, we used the available data for qualitative analysis.1. Change in mean number of migraine headache days:In the two articles, compared with placebo, tonabersat change the mean number of migraine headache days had no statistical difference (P=0.14and P=0.09).2.Change in attacks:In the two articles, one was statistically significant (P=0.01), the other has no statistical significance (P=0.13).3. Responder rates:In the study of Goadsby, the overall50%responder rate comparing the number of headache days during baseline with month3of treatment for tonabersat was59%compared with placebo at49%(P=0.22). However, the other study did not present the result.4. The reduction of the consumption of rescue medication:In the two randomized controlled trials (RCTs), tonabersat group compared to the placebo group had no statistical significance (P=0.07and P=0.02).5. Adverse events:No serious adverse events were reported in the two studies.Conclusion:This is a fair evidence for migraine prophylaxis, with a lack of available evidence for tonabersat for migraine prophylaxis. Although tonabersat failed to demonstrate a significantly greater reduction of migraine headache days than placebo, it was well tolerated. Future work should further investigate the utility of tonabersat in the preventive management of migraine.