PMID- 37723470
OWN - NLM
STAT- MEDLINE
DCOM- 20230920
LR  - 20231121
IS  - 1129-2377 (Electronic)
IS  - 1129-2369 (Print)
IS  - 1129-2369 (Linking)
VI  - 24
IP  - 1
DP  - 2023 Sep 18
TI  - Efficacy and safety of intranasal agents for the acute treatment of migraine: a 
      systematic review and network meta-analysis.
PG  - 129
LID - 10.1186/s10194-023-01662-6 [doi]
LID - 129
AB  - BACKGROUND: Intranasal agents may be ideal for the treatment of migraine 
      patients. Many new acute intranasal-specific therapies have been developed, but 
      few of them have been directly compared. The aim of this network meta-analysis 
      (NMA) was to compare the efficacy and safety of various intranasal agents for the 
      treatment of acute migraine in adult patients. METHODS: The Cochrane Register of 
      Controlled Trials, Embase, and PubMed were searched from inception to 15 August 
      2023. Randomized controlled trials (RCTs) using intranasal agents (no 
      restrictions on dose, formulation, dosing regimen or timing of the first dose) to 
      treat adult patients with acute migraine were included. The primary efficacy 
      endpoint was pain freedom at 2 h, and the primary safety endpoint was adverse 
      events (AEs). The analysis process followed the Preferred Reporting Items for 
      Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Nineteen 
      studies (21 RCTs, 9738 participants) were included. Compared to the placebo, 5 mg 
      of zolmitriptan using a conventional liquid nasal spray device was the most 
      effective for pain freedom at 2 h [odds ratio (OR): 4.67, 95% confidence interval 
      (CI): 3.43 to 6.43] and 24 h (OR: 5.49, 95% CI: 3.58 to 8.42) among all the 
      interventions. Butorphanol nasal spray 1 mg was the most effective (OR: 8.62, 95% 
      CI: 1.11 to 66.92) for pain freedom at 1 h, but with low-quality evidence. DFN-02 
      presented the highest freedom from nausea (OR: 4.95, 95% CI: 1.29 to 19.01) and 
      phonophobia (OR: 5.36, 95% CI: 1.67 to 17.22) at 2 h, albeit with lower odds of 
      achieving complete pain freedom. ROX-828 showed the highest improvement in 
      freedom from photophobia at 2 h (OR: 4.03, 95% CI: 1.66 to 9.81). 
      Dihydroergotamine nasal spray was significantly associated with the highest risk 
      of AEs (OR: 9.65, 95% CI: 4.39 to 21.22) and was not recommended for routine use. 
      Zavegepant nasal spray demonstrated the lowest risk of AEs (OR: 2.04, 95% CI: 
      1.37 to 3.03). The results of sensitivity analyses for the primary endpoints 
      (pain freedom at 2 h and AEs) were generally consistent with those of the base 
      case model. CONCLUSIONS: Compared with other new intranasal-specific therapies in 
      treating migraine attacks, zolmitriptan nasal spray 5 mg was the most effective 
      agent for pain freedom at 2 h. Zavegepant nasal spray 10 mg had the fewest 
      adverse side effects.
CI  - (c) 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.
FAU - Li, Guanglu
AU  - Li G
AD  - Graduate School of Beijing, University of Chinese Medicine, Beijing, China.
AD  - Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
FAU - Duan, Shaojie
AU  - Duan S
AD  - Department of Geriatrics, Taizhou Central Hospital (Taizhou University Hospital), 
      Taizhou, China.
FAU - Zhu, Tiantian
AU  - Zhu T
AD  - Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
FAU - Ren, Zhiying
AU  - Ren Z
AD  - Graduate School of Beijing, University of Chinese Medicine, Beijing, China.
AD  - Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
FAU - Xia, Hui
AU  - Xia H
AD  - Graduate School of Beijing, University of Chinese Medicine, Beijing, China.
AD  - Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
FAU - Wang, Ziyao
AU  - Wang Z
AD  - Graduate School of Beijing, University of Chinese Medicine, Beijing, China.
AD  - Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
FAU - Liu, Lei
AU  - Liu L
AD  - Department of Neurology, China-Japan Friendship Hospital, Beijing, China. 
      neurologyliulei@126.com.
FAU - Liu, Zunjing
AU  - Liu Z
AD  - Department of Neurology, Peking University People's Hospital, Beijing, China. 
      liuzunjing@163.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20230918
PL  - England
TA  - J Headache Pain
JT  - The journal of headache and pain
JID - 100940562
RN  - 2FS66TH3YW (zolmitriptan)
RN  - 0 (Nasal Sprays)
RN  - 0 (Oxazolidinones)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Nasal Sprays
MH  - Network Meta-Analysis
MH  - *Migraine Disorders/drug therapy
MH  - *Oxazolidinones
PMC - PMC10506288
OTO - NOTNLM
OT  - Acute treatment
OT  - Intranasal agents
OT  - Migraine
OT  - Network meta-analysis
COIS- The authors declare no competing interests.
EDAT- 2023/09/19 00:43
MHDA- 2023/09/20 06:42
PMCR- 2023/09/18
CRDT- 2023/09/18 23:45
PHST- 2023/07/27 00:00 [received]
PHST- 2023/08/28 00:00 [accepted]
PHST- 2023/09/20 06:42 [medline]
PHST- 2023/09/19 00:43 [pubmed]
PHST- 2023/09/18 23:45 [entrez]
PHST- 2023/09/18 00:00 [pmc-release]
AID - 10.1186/s10194-023-01662-6 [pii]
AID - 1662 [pii]
AID - 10.1186/s10194-023-01662-6 [doi]
PST - epublish
SO  - J Headache Pain. 2023 Sep 18;24(1):129. doi: 10.1186/s10194-023-01662-6.