Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications
BackgroundWhile memantine has been considered a promising drug for migraine prevention, no conclusive evidence exists comparing its efficacy with other migraine-preventive medications. This network meta-analysis (NMA) aimed to access the effectiveness and acceptability of memantine and other guideli...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1496621/full |
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| author | Guanglu Li Guanglu Li Baoquan Qu Tao Zheng Shaojie Duan Lei Liu Zunjing Liu |
| author_facet | Guanglu Li Guanglu Li Baoquan Qu Tao Zheng Shaojie Duan Lei Liu Zunjing Liu |
| author_sort | Guanglu Li |
| collection | DOAJ |
| description | BackgroundWhile memantine has been considered a promising drug for migraine prevention, no conclusive evidence exists comparing its efficacy with other migraine-preventive medications. This network meta-analysis (NMA) aimed to access the effectiveness and acceptability of memantine and other guideline-recommended prophylactic agents for migraine.MethodsWe searched the Cochrane Register of Controlled Trials, Embase, PubMed, and ClinicalTrials databases from their inception to 1 June 2024. Randomized placebo-controlled trials (RCTs) examining the pharmacological prevention of adult migraine patients were included. The primary efficacy outcome was the change in migraine days, and the primary safety outcome was withdrawal due to adverse events. Secondary outcomes included 50% response rates and frequency of any adverse events. The analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThirty-eight RCTs, including a total of 13,223 participants, were analyzed. Our analysis showed that memantine demonstrated the second-largest reduction in migraine days [standardized mean difference (SMD): −0.83; 95% confidence interval (CI): −1.26, −0.41 compared with placebo] and the highest 50% response rates [odds ratio (OR): 5.58, 95% CI: 1.31 to 23.69] in all studied interventions. Moreover, among all interventions, memantine appeared to show the lowest dropout rate and moderate frequency of adverse events. However, its confidence intervals contained null values.ConclusionThis study provides prioritisation evidence for memantine in migraine prevention, as memantine can significantly decrease the frequency of migraine attacks, improves response rates, and fair acceptability. These beneficial effects were not inferior to currently recommended pharmacological regimens. However, due to the lack of long-term efficacy and safety data, as well as few direct comparisons with active control agents, the estimates of memantine may be overly optimistic. Clinicians should interpret the findings of current NMA cautiously and apply them in a relatively conservative manner. |
| format | Article |
| id | doaj-art-d0c7401d823e44a7a589eeb6ef84db12 |
| institution | OA Journals |
| issn | 1663-9812 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-d0c7401d823e44a7a589eeb6ef84db122025-08-20T02:37:06ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122024-12-011510.3389/fphar.2024.14966211496621Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medicationsGuanglu Li0Guanglu Li1Baoquan Qu2Tao Zheng3Shaojie Duan4Lei Liu5Zunjing Liu6Beijing University of Chinese Medicine, Beijing, ChinaDepartment of Neurology, China-Japan Friendship Hospital, Beijing, ChinaBeijing University of Chinese Medicine, Beijing, ChinaBeijing University of Chinese Medicine, Beijing, ChinaDepartment of Geriatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, ChinaDepartment of Neurology, China-Japan Friendship Hospital, Beijing, ChinaDepartment of Neurology, Peking University People’s Hospital, Beijing, ChinaBackgroundWhile memantine has been considered a promising drug for migraine prevention, no conclusive evidence exists comparing its efficacy with other migraine-preventive medications. This network meta-analysis (NMA) aimed to access the effectiveness and acceptability of memantine and other guideline-recommended prophylactic agents for migraine.MethodsWe searched the Cochrane Register of Controlled Trials, Embase, PubMed, and ClinicalTrials databases from their inception to 1 June 2024. Randomized placebo-controlled trials (RCTs) examining the pharmacological prevention of adult migraine patients were included. The primary efficacy outcome was the change in migraine days, and the primary safety outcome was withdrawal due to adverse events. Secondary outcomes included 50% response rates and frequency of any adverse events. The analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThirty-eight RCTs, including a total of 13,223 participants, were analyzed. Our analysis showed that memantine demonstrated the second-largest reduction in migraine days [standardized mean difference (SMD): −0.83; 95% confidence interval (CI): −1.26, −0.41 compared with placebo] and the highest 50% response rates [odds ratio (OR): 5.58, 95% CI: 1.31 to 23.69] in all studied interventions. Moreover, among all interventions, memantine appeared to show the lowest dropout rate and moderate frequency of adverse events. However, its confidence intervals contained null values.ConclusionThis study provides prioritisation evidence for memantine in migraine prevention, as memantine can significantly decrease the frequency of migraine attacks, improves response rates, and fair acceptability. These beneficial effects were not inferior to currently recommended pharmacological regimens. However, due to the lack of long-term efficacy and safety data, as well as few direct comparisons with active control agents, the estimates of memantine may be overly optimistic. Clinicians should interpret the findings of current NMA cautiously and apply them in a relatively conservative manner.https://www.frontiersin.org/articles/10.3389/fphar.2024.1496621/fullmigrainememantinepreventionnetwork meta-analysissystematic review |
| spellingShingle | Guanglu Li Guanglu Li Baoquan Qu Tao Zheng Shaojie Duan Lei Liu Zunjing Liu Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications Frontiers in Pharmacology migraine memantine prevention network meta-analysis systematic review |
| title | Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications |
| title_full | Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications |
| title_fullStr | Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications |
| title_full_unstemmed | Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications |
| title_short | Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications |
| title_sort | role of memantine in adult migraine a systematic review and network meta analysis to compare memantine with existing migraine preventive medications |
| topic | migraine memantine prevention network meta-analysis systematic review |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1496621/full |
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