ABSTRACT
ObjectiveTo systematically evaluate the efficacy and safety of Rimegepant in the treatment of acute migraine. MethodsThe databases of CNKI， Wanfang and VIP database， PubMed， Embase， Cochrane Library， ClinicalTrials were searched to collect relevant literature on the treatment of Rimegepant in acute migraine. The pain freedom and Most Bothersome Symptom （MBS） freedom 2 hours after medication were the primary outcome indicators， and the other 11 indicators including pain relief 2 hours after medication were the secondary outcome indicators. The Meta-analysis was performed using RevMan 5.3， and the quality of evidence was evaluated using GRADE Profiler 3.6 for outcome indicators. ResultsA total of 4 randomized controlled studies involving 3 827 patients， including 1 840 patients in the experimental group and 1 987 patients in the control group. Meta-analysis results showed that， in terms of effectiveness， compared with the control group， the proportion of patients in the Rimegepant group who were painless 2 hours after medication （RR=1.67， 95 % CI： 1.44~1.94， P<0.01）， MBS free 2 hours after medication （RR=1.37， 95% CI： 1.24~1.51， P<0.01） and pain relief （RR=1.33， 95% CI： 1.25~1.41， P<0.01）， pain relief lasting 2~24 hours after medication （RR=1.59， 95% CI： 1.46~1.74， P<0.01）， pain relief lasting 2~48 hours after medication （RR=1.57， 95% CI： 1.42~1.74， P<0.01）， painless 2~24 hours after medication （RR=2.27， 95% CI： 1.62~3.20， P<0.01）， painless 2~48 hours after medication （RR=2.14， 95% CI： 1.52~3.02， P<0.01）， and no fear of light （RR=1.47， 95% CI： 1.32~1.64， P<0.01） and no fear of sound 2 hours after medication （RR=1.40， 95% CI： 1.19~1.64， P<0.01） was higher， the differences were statistically significant. In terms of safety， the proportion of patients with nausea （RR=1.70， 95% CI： 0.95~3.02， P=0.07）， urinary tract infection （RR=1.81， 95% CI： 0.84~3.91， P=0.13）， dizziness （RR=1.14， 95% CI： 0.49~2.63， P=0.77） or elevated transaminase （RR=0.76， 95% CI： 0.45~1.27， P=0.29） showed no statistically significant differences between the Rimegepant group and the control group. Based on GRADE criteria， evidence for Rimegepant in the treatment of acute migraine was of high or moderate quality. ConclusionRimegepant is effective for acute migraine， and the toxic effects are tolerable.
ABSTRACT
OBJECTIVE：To systemat ically evaluate the efficacy and safety of Ubrogepant and Rimegepant in the treatment of acute migraine ，and to provide evidence-based reference for the clinical treatment. METHODS ：Retrieved from PubMed ，Embase， Cochrane Library ，CNKI，VIP，Wanfang database and Clinicaltrials. gov ，randomized controlled trials （RCTs） about the Ubrogepant and Rimegepant （trial group ）versus placebo （control group ）in the treatment of acute migraine were collected during the inception to Jan. 2020. After literature screening and data extraction ，quality assessment was performed using the bias risk assessment tool provided by the Cochrane system evaluator manual 5.1.0. Meta-analysis was performed by using Stata 16.0 software. RESULTS ：Eight RCTs with a total of 7 989 patients were included. The results of Meta-analysis showed that the proportion of patients who were free from pain at 2 h postdose in Ubrogepant group [RR ＝1.65，95％CI（1.38，1.98），P＜0.001] and Rimegepant group [RR ＝1.69，95％CI（1.46，1.95），P＜0.001]，the proportion of patients who were free from the most bothersome symptom at 2 h postdose in Ubrogepant group [RR ＝1.35，95％ CI（1.20，1.53），P＜0.001] and Rimegepant group [RR ＝1.37，95％CI（1.24，1.51），P＜0.001]，and other secondary outcome indicators （ i.e. the proportion of patients with pain relief at 2 h postdose ，the proportion of patients with sustained freedom from pain from 2-24 h postdose ，the proportion of patients with sustained pain relief from 2-24 h postdose ，the proportion of patients without photophobia at 2 h postdose ，the proportion of patients without phonophobia at 2 h postdose ，the proportion of patients without nausea at 2 h postdose ）were all significantly better than control group （P＜0.05）. In terms of safety ，there was no statistical significance in the incidence of total ADR between Ubrogepant group and control group [RR ＝1.04，95％CI（0.87，1.25），P＝0.646]，but the incidence of total ADR in Rimegepant group were significantly higher than control group [RR ＝1.23，95％ CI（1.01，1.50），P＝0.043]. There was no statistical significance in other security indicators （i.e. incidence of nausea ，dizziness，dry mouth ，somnolence，urinary tract infection）in 2 groups（P＞0.05）. CONCLUSIONS ：Ubrogepant and Rimegepant are effective in the treatment of acute migraine. Ubrogepant is safe ，while Rimegepant may increase the incidence of ADR.
ABSTRACT
Objective: To investigate the intervention effect of Dachuanxiong Fang multi-component preparation on acute migraine rats, in order to explore the possible mechanism by using urine metabolomics technology. Method: The forty SD rats were randomly divided into 5 groups (n=8), control group, model group, low-dose Dachuanxiong Fang multi-component preparation (DCXF) group (0.19 g·kg-1), medium-dose DCXF group (0.37 g·kg-1), and high-dose DCXF group (0.74 g·kg-1). Rats were subcutaneously injected with 10 mg·kg-1 nitroglycerin for modeling, and Dachuanxiong Fang multi-component preparation was administered through intragastric administration. After half an hour of administration, blood was collected from the abdominal aorta, and the content of 5-hydroxytryptamine (5-HT), 5-hydroxyindole-3-acetic acid (5-HIAA), nitric oxide (NO), nitric oxide synthase (NOS), calcitonlin gene related peplide (CGRP), dopamine(DA) in plasma were determined by enzyme-linked immuno sorbent assay (ELISA) kits. The contents of 5-HT and NOS in the hypothalamus and brainstem of the control group and the model group were analyzed, and the average optical density value was used for statistical analysis. UPLC-TOF/MS combined with principal component analysis (PCA) analysis was used to analyze different groups of rats and discover differential metabolites. Differential metabolites were analyzed by MetaboAnalyst 3.0 software for possible metabolic pathways. Result: After modeling, compared with the control group, the content of neurotransmitters in the model group was significantly increased (PPPβ-hydroxybutyrate showed an upward trend. According to the metabolic pathway prediction study, metabolic pathways with a higher correlation were found to be alanine, aspartic acid and glutamate metabolism, propionic acid metabolism, nitrogen metabolism and tryptophan metabolism. Conclusion: The possible metabolism pathway of Dachuanxiong Fang multi-component preparation is mainly amino acid metabolism in urine, and kynurenine is also the product of tryptophan metabolism pathway. The kynurenine metabolic pathway is also one of the main pathways of tryptophan metabolism.
ABSTRACT
OBJECTIVE:To observe the clinical efficacy and safety of flunarizine combined with salvianolate in the treatment of acute migraine. METHODS:A total of 72 patients with acute migraine were randomly divided into control group(36 cases)and observation group (36 cases). Based on routine treatment,control group was given Flunarizine hydrochloride capsules orally,10 mg for 65 year-old and below once a day,5 mg for more than 65 year-old once a day. Observation group was additionally given Flunarizine hydrochloride for injection 200 mg intravenously,once a day,on the basis of control group. Both groups were treated contineously till cured or for 2 weeks. Clinical efficacy,onset time,recovery time,VAS score,frequency and duration of head-ache attack,ADR were observed in 2 groups. RESULTS:In the course of treatment,the two groups did not terminate and fall off, and all of them completed the treatment. The total response rate(97.22%)of observation group was significantly higher than that (86.11%)of control group;onset time and recovery time of observation group were both shorter than those of control group,with statistical significance (P0.05). After treatment,VAS score,frequency and duration of headache attack in 2 groups were all significantly lower than before,and the observation group was significantly lower than the control group,with statistical significance (P0.05). CONCLU-SIONS:Based on routine treatment,flunarizine hydrochloride capsules combined with Salvianolate injection show significant effica-cy for acute migraine with good safety.