Meta-analysis of randomized trials on percutaneous patent foramen ovale closure for prevention of migraine
Meta-analysis of randomized trials on percutaneous patent foramen ovale closure for prevention of migraine
复制标题
DOI：
10.1080/00015385.2018.1475027
复制
发表时间：
2019-01-01
影响因子：
1.6
通讯作者：
Saad, Marwan
中科院分区：
文献类型：
--
作者：
Elbadawi, Ayman;Barssoum, Kirolos;Saad, Marwan
背景：经皮卵圆孔未闭（PFO）封堵在预防偏头痛中的作用是有争议的。方法：截至2017年12月，我们对MEDLINE、EMBASE和COCHRANE数据库进行了计算机化检索，以评估偏头痛患者（有或无先兆）PFO闭合与对照组的随机试验。主要研究结果是与对照组相比，PFO关闭后每月偏头痛发作次数减少。结果：最终分析包括三个随机试验，共484例患者。与对照组相比，PFO关闭组每月偏头痛发作的减少率更高（标准化平均差异- smd = 0.25; 95% CI: 0.06-0.43; p = 0.01）。与对照组相比，PFO闭合组每月偏头痛天数减少较多（SMD = 0.30; 95% CI: 0.08-0.53; p = 0.01）。在偏头痛发作完全缓解（OR: 3.67; 95% CI: 0.66-20.41; p = 0.14）和响应者率（OR: 1.92; 95% CI: 0.76-4.85; p = 0.17）方面，PFO关闭组与对照组之间无统计学差异。在大多数偏头痛发作为先兆的患者中，与对照组相比，PFO关闭后偏头痛发作减少（SMD = 0.86; 95% CI: 0.07-1.65; p = 0.03）。结论：PFO关闭可能对偏头痛患者有益，可减少偏头痛发作和偏头痛天数，特别是对先兆偏头痛发作的患者。然而，这些益处与反应者发病率的改善或偏头痛的完全缓解无关；引起对PFO关闭在偏头痛预防中的临床获益程度的关注。
Background: The role of percutaneous patent foramen ovale (PFO) closure for prevention of migraine is controversial.Methods: We performed a computerised search of MEDLINE, EMBASE and COCHRANE databases through December 2017 for randomised trials evaluating PFO closure versus control in patients with migraine headaches (with or without aura). The main study outcome was the reduction in monthly migraine attacks after PFO closure compared with the control group.Results: The final analysis included three randomised trials with a total of 484 patients. Reduction in monthly migraine attacks was higher in PFO closure compared with the control group (standardised mean difference-SMD = 0.25; 95% CI: 0.06-0.43; p =.01). There was higher reduction of monthly migraine days in PFO closure group compared with control group (SMD = 0.30; 95% CI: 0.08-0.53; p =.01). There was no statistically significant difference in complete resolution of migraine attacks (OR: 3.67; 95% CI: 0.66-20.41; p =.14) and in responders' rate (OR: 1.92; 95% CI: 0.76-4.85; p =.17) between PFO closure and control groups. In patients whose majority of migraine attacks are with aura, there was an observed reduction in migraine attacks in PFO closure compared with control groups (SMD = 0.86; 95% CI: 0.07-1.65; p =.03).Conclusion: PFO closure might be beneficial in migraine patients by reducing migraine attacks and migraine days, especially in patients whose majority of migraine attacks are with aura. However, those benefits were not associated with an improvement in responders' rate or complete resolution of migraine; raising concerns on the magnitude of clinical benefit of PFO closure in migraine prevention.