STUDY OBJECTIVE We performed a systematic review and Bayesian network meta-analysis to determine which pharmacologic therapies are relatively more effective and safer for migraine in adult patients who present to the emergency department (ED). METHODS We searched MEDLINE, Embase, and Web of Science from inception to February 9, 2024. Eligible studies were randomized controlled trials that enrolled adult participants presenting to ED with migraine and compared one pharmacologic therapy to another or placebo. Outcomes were as follows: 1) adequate pain relief at 2 hours, 2) change in pain intensity at 1 hour, 3) need for rescue drug at 2 hours, and 4) significant adverse reaction. We extracted data according to PRISMA-network meta-analysis and appraised trials using Cochrane RoB 2. For dichotomous outcomes, we performed Bayesian network meta-analysis to calculate odds ratios with 95% credible intervals; for continuous outcomes, we performed frequentist network meta-analysis to calculate mean differences with 95% confidence intervals. We assessed confidence using Confidence in Network Meta-analysis. We used Surface under the cumulative ranking curve (SUCRA) to rank agents. RESULTS Chlorpromazine intravenous (IV)/intramuscular (IM) (SUCRA=87.3%) was most likely to be superior for "adequate pain relief at 2 hours" (24 trials; n=2,361); metoclopramide IV-ibuprofen IV (SUCRA=94.6%) was most likely to be superior for "need for rescue drug" (not needing rescue drug) at 2 hours (27 trials; n=2,942); dexamethasone IV (SUCRA=79.5%) was most likely to be superior for "significant adverse reaction" (not causing adverse reaction) (22 trials; n=2,450). The network for change in pain intensity demonstrated statistically significant incoherence at the overall level. Confidence in network meta-analysis estimates (certainty of evidence) varied and was mostly "low" or "very low," limiting the validity of the probabilistic analyses. CONCLUSIONS According to Bayesian network meta-analysis, ibuprofen IV is definitely among the least effective for adequate pain relief; chlorpromazine IV/IM is definitely among the most effective; valproate IV is definitely among the least effective, and ketorolac IV/IM is possibly among the least effective as single agents. The relative safety of the pharmacologic therapies cannot be determined with sufficient certainty.

中文翻译：

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急诊科偏头痛药物治疗的有效性和安全性：系统评价和贝叶斯网络荟萃分析。


研究目的： 我们进行了一项系统评价和贝叶斯网络荟萃分析，以确定哪些药物治疗对急诊科 （ED） 就诊的成年患者的偏头痛相对更有效和安全。方法 我们检索了从建库到 2024 年 2 月 9 日的 MEDLINE、Embase 和 Web of Science。符合条件的研究是随机对照试验，这些试验招募了因偏头痛而出现 ED 的成年参与者，并将一种药物治疗与另一种药物疗法或安慰剂进行了比较。结局如下： 1） 2 小时疼痛充分缓解，2） 1 小时疼痛强度变化，3） 2 小时需要抢救药物，4） 显着不良反应。我们根据 PRISMA 网状meta分析提取资料，并使用 Cochrane RoB 2 评价试验。对于二分类结局，我们进行了贝叶斯网络meta分析，以计算具有95%可信区间的比值比;对于连续结局，我们进行了频率主义网络meta分析，以计算平均差和95%置信区间。我们使用 Confidence in Network Meta 分析评估了可信度。我们使用累积排名曲线下表面 （SUCRA） 对代理进行排名。结果氯丙嗪静脉注射（IV）/肌内注射（IM）（SUCRA=87.3%）最有可能优于“2小时充分缓解疼痛”（24项试验;n=2,361）;甲氧氯普胺IV-布洛芬IV（SUCRA=94.6%）最有可能在2小时时“需要急救药物”（不需要急救药物）（27项试验;n=2,942）;地塞米松静脉注射（SUCRA=79.5%）最有可能优于“显著不良反应”（不引起不良反应）（22项试验;n=2,450）。疼痛强度变化网络在整体水平上表现出统计学上显着的不连贯性。 网络荟萃分析估计的可信度（证据质量）各不相同，大多为“低”或“极低”，限制了概率分析的有效性。结论 根据贝叶斯网络荟萃分析，布洛芬 IV 绝对是充分缓解疼痛效果最差的药物之一;氯丙嗪 IV/IM 绝对是最有效的药物之一;丙戊酸钠 IV 绝对是效果最差的药物之一，而酮咯酸 IV/IM 可能是作为单一药物效果最差的药物之一。无法充分确定药物治疗的相对安全性。