ABSTRACT
Purpose: Calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) are new agents approved by the US Food and Drug Administration for preventive treatment of chronic migraine. Comparison between CGRPmAbs and previously approved Botulinum neurotoxin A (BoNT-A) will inform optimal preventive treatment of chronic migraine, but head-to-head trials are lacking. We therefore aimed to perform adjusted indirect comparison between CGRPmAbs and BoNT-A through a meta-analysis. Methods: OVID MEDLINE, EMBASE and the Cochrane central register of controlled trials, clinical registries, and government websites were searched from inception to September 2019. Randomized controlled trials comparing CGRPmAbs or BoNT-A with placebo in the preventive treatment of chronic migraine were included. The primary outcomes were headache days and migraine days measured at week 12. Data were synthesized by using a frequentist approach; and the treatments were ranked by P-score. Results: We included 10 trials (n = 4,678) after screening 1049 candidates. Six trials were with low risk of bias. Fremanezumab had an effect similar to BoNT-A in the reduction of headache days at week 12 (standard mean difference [SMD] 0.08, 95%CI -0.55 to -0.7). Galcanezumab reduced more migraine days than BoNT-A at week 12 (SMD, -0.94, 95%CI -1.24 to -0.63); fremanezumab showed similar findings (SMD, -0.55, 95%CI -0.85 to -0.24). Galcanezumab and fremanezumab had better effect in mitigating headache impact at week 12. CGRPmAbs and BoNT-A had similar adverse event rate. Conclusion: CGRPmAbs and BoNT-A had similar effect in the preventive treatment of chronic migraine. BoNT-A might be preferentially selected owing to its cost-effectiveness profiles. Further studies with direct comparison of the two treatments are warranted.
ABSTRACT
BACKGROUND: Propranolol is recommended as first-line treatment for preventing migraine attacks; acupuncture has not been compared with propranolol in a head-to-head trial. OBJECTIVE: To compare acupuncture with propranolol using indirect treatment comparison meta-analysis. METHOD: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials comparing acupuncture or propranolol with sham acupuncture, placebo, waiting-list control or usual care were included. We extracted information from the included trials using a standardized extraction form. The primary outcome was migraine episodes. The secondary outcomes included migraine days, migraine frequency, and adverse events. RESULTS: We included 19 RCTs (n = 3656) after screening 1078 articles. The analysis showed that acupuncture had a significant advantage over propranolol in reducing migraine episodes over a 4-week period (SMD - 0.74, 95% CI - 1.04 to - 0.44). Acupuncture also had a significant advantage over waiting-list control in decreasing migraine frequency (SMD - 1.57, 95% CI - 2.08 to - 1.06). Acupuncture caused fewer adverse events than propranolol (RR 0.82, 95% CI 0.11-5.94). CONCLUSIONS: Acupuncture had a better effect than propranolol in reducing migraine episodes in indirect comparison. The result should be confirmed in subsequent head-to-head studies. Registration: PROSPERO CRD42018108585.
Subject(s)
Acupuncture Therapy , Adrenergic beta-Antagonists/pharmacology , Migraine Disorders/drug therapy , Migraine Disorders/prevention & control , Outcome Assessment, Health Care , Propranolol/pharmacology , HumansABSTRACT
BACKGROUND: Patients with functional chronic constipation (CFC) often select nonpharmacological treatments. We aimed to examine the comparative effectiveness of nonpharmacological conservative treatments in treating CFC. METHODS: We searched MEDLINE, EMBASE, Cochrane library, CINAHL, AMED, ISI web of knowledge, and conference proceedings from January 2000 to June 2016. Randomized controlled trials comparing nonpharmacological conservative treatments with placebo, sham interventions, or conventional treatments were included. Nonpharmacological conservative treatments were defined as interventions without involvement of medication or surgery. We extracted trial data in duplicate and assessed the risk of bias. We pooled continuous data using standard mean differences (SMDs) and binary data using risk ratios (RRs), and we provided their 95% confidence intervals. KEY RESULTS: We included 33 trials (4324 participants and 8 nonpharmacological treatments). Compared with placebo interventions, TENS (SMD 1.60, 95% CI 0.28-2.92), probiotic (SMD 1.40, 95% CI 0.94-1.86), and acupuncture (SMD 1.00, 95% CI 0.39-1.60) had significantly larger effect on stool frequency; acupuncture (RR 1.56, 95% CI 1.14-2.14) had significantly higher responder rate; and moxibustion (SMD 2.50, 95% CI 0.05-4.95) had significant larger effect on Bristol score. Compared with laxative, acupuncture had significantly larger effect on stool frequency (RR 2.01, 95% CI 1.16-3.49) and had lower rate of adverse events (RR 0.38, 95% CI 0.18-0.80). CONCLUSIONS: TENS and acupuncture relatively ranked the best in managing CFC, but the results should be interpreted with caution due to small study effects. Registration number: PROSPERO CRD42014006686.
Subject(s)
Colonic Diseases, Functional/therapy , Conservative Treatment/methods , Constipation/therapy , HumansABSTRACT
BACKGROUND: Several pharmacological treatments are recommended by guidelines with moderate to high evidence for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D), but the comparative effectiveness and safety among these treatments are unknown. The review is to assess the comparative effectiveness and safety of pharmacological treatments for IBS-D using network meta-analysis. METHODS: We will search Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant randomized controlled trials (RCTs) that compare guideline-recommended pharmacological treatments with placebo or one of the treatments. We will include RCTs that recruit patients with IBS-D, RCTs that assess the improvement in IBS-D global symptoms, abdominal pain, stool frequency, or stool consistency, and RCTs that assess the responder rate and adverse event rate. We will use standardized mean difference to synthesize continuous variables and use odds ratio to synthesize categorical variables. Traditional meta-analysis will be performed to assess the comparative effectiveness of the pharmacological treatments in direct evidence, and network meta-analysis will be performed to combine both direct and indirect evidence. Transitivity of the evidence in the network will be assessed by using a generalized Cochrane Q statistic and net-heat plot. CONCLUSIONS: The result of the review will inform clinical decisions for clinicians, patients, and police makers in the treatment of IBS-D. RESULTS: Ethical approval and informed consent are not required for this systematic review. We will disseminate the result through a peer-reviewed journal and conference abstracts. PROSPERO REGISTRATION NUMBER: PROSPERO CDR42018099294.
