Sumatriptan (intranasal route of administration) for acute migraine attacks in adults.
Sumatriptan (intranasal route of administration) for acute migraine attacks in adults.
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DOI：
10.1002/14651858.cd009663
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发表时间：
2012-02-15
影响因子：
8.4
通讯作者：
Moore, R. Andrew
中科院分区：
文献类型：
--
作者：
Derry, Christopher J.;Derry, Sheena;Moore, R. Andrew
偏头痛是一种高度致残的个人条件，也有广泛的影响，社会，医疗保健服务和经济。舒马曲坦是一种治疗偏头痛发作的流产药物，属于曲坦家族。对于出现恶心和/或呕吐的个体，鼻内给药可能优于口服给药，尽管其主要在肠道而不是鼻粘膜中吸收。确定鼻内舒马曲坦与安慰剂和其他积极干预治疗成人急性偏头痛发作的疗效和耐受性。我们检索了截至2011年10月13日的科克伦对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE、在线数据库和参考文献列表。我们纳入了使用鼻内舒马曲坦治疗偏头痛发作的随机、双盲、安慰剂和/或活性对照研究，每个治疗组至少有10名受试者，两位综述作者独立评估了试验质量并提取了数据。我们使用达到每个结果的参与者数量来计算相对风险（或“风险比”）以及与安慰剂或不同的活性治疗相比需要治疗获益（NNT）或伤害（NNH）的人数。12项研究（4755名参与者）比较了鼻内舒马曲坦与安慰剂或活性对照剂。大部分数据来自10 mg和20 mg剂量。舒马曲坦在所有疗效结局方面均优于安慰剂。舒马曲坦10 mg与安慰剂相比，两小时后疼痛消失的NNT分别为7.3、7.4和5.5，一小时和两小时后头痛缓解的NNT分别为7.3、7.4和5.5。对于相同的结果，舒马曲坦20 mg与安慰剂相比，NNT分别为4.7、4.9和3.5。对于这三个主要疗效结局，20 mg剂量均显著优于10 mg剂量。与安慰剂相比，舒马曲坦对头痛相关症状（包括恶心、恐惧症和声音恐惧症）的缓解效果更好，并且舒马曲坦的急救药物使用率低于安慰剂。在大多数情况下，不良事件是短暂的和轻微的，舒马曲坦比安慰剂更常见。舒马曲坦与活性治疗的直接比较仅限于两项研究，一项比较舒马曲坦20 mg和双氢麦角胺（DHE）1 mg，另一项比较舒马曲坦20 mg和利扎曲坦10 mg。舒马曲坦鼻内给药可有效治疗急性偏头痛发作，缓解疼痛、恶心、恐惧症、声音恐惧症和功能障碍，但与安慰剂相比，其不良事件增加。
Migraine is a highly disabling condition for the individual and also has wide-reaching implications for society, healthcare services, and the economy. Sumatriptan is an abortive medication for migraine attacks, belonging to the triptan family. Intranasal administration may be preferable to oral for individuals experiencing nausea and/or vomiting, although it is primarily absorbed in the gut, not the nasal mucosa. To determine the efficacy and tolerability of intranasal sumatriptan compared to placebo and other active interventions in the treatment of acute migraine attacks in adults. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, online databases, and reference lists for studies through 13 October 2011. We included randomised, double-blind, placebo- and/or active-controlled studies using intranasal sumatriptan to treat a migraine headache episode, with at least 10 participants per treatment arm. Two review authors independently assessed trial quality and extracted data. We used numbers of participants achieving each outcome to calculate relative risk (or ‘risk ratio’) and numbers needed to treat to benefit (NNT) or harm (NNH) compared to placebo or a different active treatment. Twelve studies (4755 participants) compared intranasal sumatriptan with placebo or an active comparator. Most of the data were for the 10 mg and 20 mg doses. Sumatriptan surpassed placebo for all efficacy outcomes. For sumatriptan 10 mg versus placebo the NNTs were 7.3, 7.4, and 5.5 for pain-free at two hours, and headache relief at one and two hours, respectively. For sumatriptan 20 mg versus placebo the NNTs were 4.7, 4.9, and 3.5, respectively, for the same outcomes. The 20 mg dose was significantly better than the 10 mg dose for each of these three primary efficacy outcomes. Relief of headache-associated symptoms, including nausea, photophobia, and phonophobia, was greater with sumatriptan than with placebo, and use of rescue medication was lower with sumatriptan than placebo. For the most part, adverse events were transient and mild and were more common with sumatriptan than placebo. Direct comparison of sumatriptan with active treatments was limited to two studies, one comparing sumatriptan 20 mg and dihydroergotamine (DHE) 1 mg, and one comparing sumatriptan 20 mg with rizatriptan 10 mg. Intranasal sumatriptan is effective as an abortive treatment for acute migraine attacks, relieving pain, nausea, photophobia, phonophobia, and functional disability, but is associated with increased adverse events compared with placebo.