Efficacy and safety of analgesics for migraine in adults indexed on World Health Organizations Essential Medicines List : master's thesis

Abstract

Uvod: Migrene su najčešća vrsta glavobolje s većom pojavnošću u žena (18%) nego muškaraca (6%), od čega je gotovo polovica nedijagnosticirana ili krivo liječena. Terapija migrene dijeli se na akutnu i preventivnu, međutim, najčešće su potrebne obje vrste terapije. Na Osnovnoj listi lijekova Svjetske zdravstvene organizacije (SZO EML) nalaze se tri analgetika s indikacijom liječenja akutnog napadaja migrene: acetilsalicilna kiselina (ASK), ibuprofen i paracetamol. Cilj istraživanja: Procijeniti djelotvornost i sigurnost analgetika za migrenu kod odraslih koji se nalaze na Osnovnoj listi lijekova Svjetske zdravstvene organizacije (SZO EML) temeljem dokaza iz sustavnih pregleda randomiziranih kontroliranih pokusa. Metode: Pretražene su četiri bibliografske baze podataka Embase, MEDLINE, CDSR i DARE do datuma 16. veljače 2016. Uključeni su sustavni pregledi koji su proučavali djelotvornost i sigurnost ASK, ibuprofena i/ili paracetamola u usporedbi s placebom i/ili aktivnim komparatorom u terapiji migrene u odraslih. Dva autora su neovisno izvršila probir i izvadila podatke iz uključenih sustavnih pregleda. Kvaliteta sustavnih pregleda procijenjena je ljestvicom AMSTAR za procjenu kvalitete sustavnih pregleda. Rezultati: Uključeno je 12 sustavnih pregleda koji su proučavali djelotvornost i sigurnost ASK, paracetamola i ibuprofena za odrasle osobe s migrenom. Osam sustavnih pregleda koji su analizirali ASK došli su do jednakog zaključka da je ASK učinkovitija od placeba u terapiji migrene u odraslih. Sustavni pregledi koji su kao aktivni komparator imali sumatriptan zaključili su da nema statistički značajne razlike u djelotvornosti ASK i sumatriptana, ali da se zbog manjeg broja nuspojava ASK može preporučiti prije triptana. Pet sustavnih pregleda koji su analizirali paracetamol došli su do zaključka da je paracetamol značajno učinkovitiji od placeba, osim jednog sustavnog pregleda koji daje slabu preporuku za primjenu paracetamola, jer su nuspojave veće od moguće koristi u terapiji akutnog napada migrene. Sedam sustavnih pregleda koji su analizirali ibuprofen imaju jednaki zaključak da je ibuprofen značajno učinkovitiji od placeba u terapiji migrene u odraslih. Sustavni pregledi koji su obuhvaćali i aktivne komparatore zaključili su da je ibuprofen podjednako učinkovit kao rofekoksib, kombinacija ASK i metoklopramida i niske doze sumatriptana i naratriptana. Nuspojave u primjeni ibuprofena su uglavnom blage i prolazne, bez značajne razlike u pojavnosti od placeba. Zaključak: Analiza dostupnih dokaza iz sustavnih pregleda o djelotvornosti i sigurnosti ASK, ibuprofena i paracetamola pokazuje da su ti lijekovi opravdano uvršteni na SZO EML kao lijekovi za migrenu odraslih.Background: Migraines are one of the most common types of headache with higher prevalence in women (18%) than in men (6%), almost half of whom are undiagnosed or undertreated. Treatment of migraine can be acute or preventive, but it often involves both types of therapy. There are three analgesics indicated as antimigraine medicines for acute attacks in adults on the World Health Organization Essential Medicines List (WHO EML): acetylsalicylic acid (ASA), ibuprofen and paracetamol. Objective: To evaluate efficacy and safety of analgesics indicated for migraine in adults on the World Health Organization Essential Medicines List (WHO EML), based on available evidence from systematic reviews (SRs) of randomized controlled trials. Methods: Four databases were searched: Embase, MEDLINE, CDSR and DARE up to 16. February 2016. Systematic reviews, which searched for efficacy and safety of ASA, ibuprofen and/or paracetamol compared to placebo and/or active comparator for treatment of migraine in adults, were included. Two review authors independently screened studies for inclusion and extracted data from the included SRs. The methodological quality of SRs was assessed using the AMSTAR tool. Results: Twelve systematic reviews assessing the efficacy and safety of ASA, paracetamol and ibuprofen for adults suffering from migraines were included. Eight systematic reviews that analyze ASA came to the same conclusion that ASA was more effective than placebo in the treatment for migraine in adults. Systematic reviews in which sumatriptan was the active comparator concluded that there was no statistically significant difference in the effectiveness of ASA and sumatriptan, but that, due to a fewer number of side effects, ASA may be recommended before a triptan. Five systematic reviews that analyzed paracetamol concluded that paracetamol is significantly more effective than placebo, except for one systematic review that gives a weak recommendation for using paracetamol, because the risk of side effects is higher than the possible benefit in the treatment of acute migraine attack. Seven systematic reviews that analyzed ibuprofen have the same conclusion that ibuprofen is significantly more effective than placebo in migraine treatment in adults. Systematic reviews that also included active comparators concluded that ibuprofen is as effective as rofecoxib, a combination of ASA and metoclopramide and low doses of sumatriptan and naratriptan. Side effects of ibuprofen were mainly mild and transient, not significantly different from that of placebo. Conclusion: The analysis of the available evidence from systematic reviews of the efficacy and safety of ASA, ibuprofen and paracetamol shows that these medicines are justifiably included in the WHO EML as treatments for migraine in adult