Sistematik Bir İnceleme ve Meta-Analiz: Pediatrik ve Ergen Popülasyonlarda Akut Migren Tedavisi

Year 2023, , 871 - 878, 30.09.2023

Emine Özdemir Kaçer , Can Ateş

https://doi.org/10.16899/jcm.1347057

Abstract

Arka Plan: Yetişkinlerde akut migreni tedavi etmek için kullanılan ilaç çeşitleri oldukça geniştir ve birçoğunun artık ayakta tedavi ortamlarında çocuklarda ve ergenlerde kullanılmasına izin verilmiştir.
Amaçlar: Bu meta-analizin amacı, 18 yaş ve altındaki bireylerde migren tedavisinde, uygulama yöntemine bakılmaksızın, plaseboya kıyasla farmakolojik müdahalelerin etkisini değerlendirmekti.
Gereçler ve Yöntemler: Mayıs 2023'ten 30 yıl önce yayınlanan karşılaştırmalı RCT'ler için PubMed, EMBASE ve Cochrane Library'yi araştırdık. Migrenli çocuk ve ergenlerde akut semptomları hafifleten migren ilaçlarını plaseboyla karşılaştıran prospektif randomize kontrollü klinik araştırmaları dahil ettik.
Bulgular: Bu meta-analize 12 klinik çalışma dahil edildi. Migren tedavisi seçimi ve tedaviden 2 saat sonra ağrıları tamamen geçen hastaların oranı analiz edildi. Analizde ibuprofen (n=2), sumatriptan (n=3), zolmitriptan (n=3) ve rizatriptan (n=4) kullanıldı. Karışık bireysel çalışma sonuçlarına rağmen (OR:1,35; %95 GA 0,81, 2,27), sumatriptan plaseboya kıyasla anlamlı farklılıklar sergilemedi. Rizatriptanın etkinliği yaş grupları arasında değişkenlik gösterdi ve 12-17 yaş arası ergenlerde anlamlı bir fark görülmedi (p>0,05). Zolmitriptan doza bağımlı etkinlik gösterdi ve daha yüksek dozlar daha iyi sonuçlar verdi (OR:2,18; %95 GA 1,45,3,28). İbuprofen, olumlu bir güvenlik profiliyle (OR:2,54; %95 CI 1,20, 5,37) 2 saatte ağrısız duruma ulaşmada etkinliğini gösteren, triptan olmayan tek ilaç olarak ortaya çıktı.
Sonuç: Bu bulgular ibuprofen, zolmitriptan ve rizatriptanın çocuk ve ergenlerde migreni hızlı bir şekilde hafifletmek için potansiyel tedavi seçenekleri olduğunu göstermektedir. Ancak ibuprofenin kullanışlılığı ve maliyet etkinliği nedeniyle triptanlara göre avantajları olabilir.

Keywords

Akut migren tedavisi, Ergen, Meta-analiz, Pediatrik, Farmakolojik müdahaleler, Randomize kontrollü çalışmalar

A Systematic Review and Meta-Analysis: Acute Migraine Treatment in Pediatric and Adolescent Populations

Abstract

Backgrounds: The array of medications used to treat acute migraine in adults is extensive, with several now authorized for use in children and adolescents in outpatient settings.
Aims: The aim of this meta-analysis was to evaluate the impact of pharmacological interventions, regardless of the method of delivery, compared to placebo, in treating migraine among individuals aged 18 years or younger.
Materials and Methods: We searched PubMed, EMBASE, and Cochrane Library for comparative RCTs published 30 years before May 2023. We included prospective randomized controlled clinical trials of children and adolescents with migraine, comparing acute symptom-relieving migraine medications with a placebo.
Results: Twelve clinical trials were included in this meta-analysis. The migraine treatment choice and the proportion of patients with complete pain relief at 2 hours post-treatment were analyzed. Ibuprofen (n=2), sumatriptan (n=3), zolmitriptan (n=3), and rizatriptan (n=4) were used for the analysis. Notably, sumatriptan did not exhibit significant differences compared to placebo, despite mixed individual study outcomes (OR:1.35; 95% CI 0.81, 2.27). Rizatriptan displayed varying efficacies across age groups, showing no significant difference in adolescents aged 12-17 years (p>0.05). Zolmitriptan showed dose-dependent effectiveness, with higher doses yielding better outcomes (OR:2.18; 95% CI 1.45,3.28). Ibuprofen emerged as the sole non-triptan medication to demonstrate efficacy in achieving pain-free status at 2 hours, with a favorable safety profile (OR:2.54; 95% CI 1.20, 5.37).
Conclusion: These findings suggest that ibuprofen, zolmitriptan, and rizatriptan are potential treatment options for rapidly relieving migraine in children and adolescents. However, ibuprofen may have advantages over triptans, owing to its convenience and cost-effectiveness.

Keywords

Acute migraine treatment, Adolescent, Meta-analysis, Pediatric, Pharmacological interventions, Randomized controlled trials

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