European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention—part 2: flunarizine
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Le résumé fourni par la source
OBJECTIVE: Novel 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. METHODS: A 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. RESULTS: Five 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). CONCLUSIONS: Published 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.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention—part 2: flunarizine
- Date Crossref
- 19/09/2023
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Athens Naval & Veterans Hospital pays non établi dans la noticeÉtablissement de santé
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University of L'Aquila Department of Biotechnological and Applied Clinical Sciences pays non établi dans la noticeUniversité ou école supérieure
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Istanbul University Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
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Istanbul University-Cerrahpaşa pays non établi dans la noticeUniversité ou école supérieure
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Universidade Católica Portuguesa Center for Interdisciplinary Research in Health pays non établi dans la noticeUniversité ou école supérieure
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Hospital da Luz Neurology Department pays non établi dans la noticeÉtablissement de santé
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Erasmus MC Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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Clinica Universidad de Navarra Department of Neurology pays non établi dans la noticeÉtablissement de santé
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Universitätsmedizin Greifswald pays non établi dans la noticeÉtablissement de santé
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Charité - Universitätsmedizin Berlin pays non établi dans la noticeÉtablissement de santé
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Vrije Universiteit Brussel Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
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Universitair Ziekenhuis Brussel pays non établi dans la noticeÉtablissement de santé
Athens Naval & Veterans Hospital, Department of Biotechnological and Applied Clinical Sciences — University of L'Aquila et Department of Neurology — Istanbul University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.