全球药物治疗成人偏头痛指南的系统评价

Guidelines concerning pharmacological intervention for migraine in adults:a systematic review

目的全面评价全球药物干预治疗成人偏头痛指南质量,比较分析不同地区、不同质量级别指南中一线药物推荐的差异,探讨药物推荐的证据基础,为临床决策提供依据。方法计算机检索PubMed、The Cochrane Library、EMbase、SinoMed、CNKI、VIP和WanFang Data、Up To Date数据库,检索医脉通、Guideline Central、GIN和NICE等指南网站,搜集药物干预治疗成人偏头痛的临床指南,检索时限均从建库至2020年1月12日。采用AGREEⅡ指南评价工具评价纳入指南的方法学质量。结果共纳入25个指南,包括22个循证指南,来自4大洲的10个国家及世界卫生组织,时间跨度为1997年~2019年。其中A级指南有5个,B级指南18个,C级指南2个。25个指南在“范围与目的”、“严谨性”、“清晰性与可读性”和“编辑的独立性”领域平均得分最高,均大于60%。不同指南在不同领域的平均得分各有侧重。有18个指南推荐了偏头痛急性发作的一线药物,推荐频次最高的是曲坦类及NSAIDs;有19个指南推荐了预防偏头痛的一线用药,β受体阻滞剂及抗癫痫药推荐频次最高;有1个中医药治疗偏头痛的临床实践指南;另有1个国外指南推荐了草药蜂斗菜做为预防用药。结论纳入的偏头痛药物治疗指南质量总体中等,循证指南的方法学质量优于非循证指南。AGREEⅡ的6个领域23个条目评分各有优劣。一线药物推荐一致性较强,但仍存在地区差异。中医药的治疗作用有待进一步验证。

Objectives To evaluate the methodological quality of guidelines for pharmacological intervention of migraine in adults,to compare and analyze the differences in first-line drug recommendations in different regions and quality levels,so as to explore the evidence of drug recommendations,and provide a basis for clinical decision-making.Methods PubMed,The Cochrane Library,EMbase,SinoMed,CNKI,VIP,and WanFang Data databases,Up To Date,as well as the related books,Yimaitong,Guideline Central,Guidelines International Network(GIN)and National Institute for Health and Clinical Excellence(NICE)were systematically searched to collect pharmacological intervention guidelines of migraine in adults from inception to January 12th,2020.The methodological quality of the guidelines was evaluated by Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ).Results A total of 25 guidelines were included(including 22 evidence-based guidelines),covering 10 countries on 4 continents and World Health Organization(WHO)with a time span of 1997 to 2019.According to AGREEⅡ,5 were A-level guidelines,18 were B-level guidelines,and 2 were C-level guidelines.Scope and purpose,rigour of development,clarity of presentations and editorial independence obtained high average scores(more than 60%)among all 25 guidelines.The average scores of guidelines in different domains of AGREEⅡvaried with regions and countries.Triptans and NSAIDs were the most frequently recommended as first-line drugs for the acute management;beta-blockers and antiepileptic drugs were recommended for the first-line prevention drugs of migraine in adults.There were 2 guidelines that recommended complementary treatments,one recommended traditional Chinese medicine and another recommended herbal butterbur.Conclusions The methodological quality of the pharmacological intervention guidelines of migraine in adults is suboptimal among different regions or countries.The quality of evidence-based guidelines is superior to that established by consensus.The consistency of first-line drug recommendations is strong,but there are still regional differences.The therapeutic effect of traditional Chinese medicine requires further verification.