在急性偏头痛治疗中使用口服三药 (血清素5-HT(1B/1D) 激活剂:对53项试验的元分析
M D Ferrari1, K I Roon, R B Lipton
1Department of Neurology, Leiden University Medical Centre, 2300 RC Leiden, Albinusdreef 2, 2333 ZA, Leiden, Netherlands. M.D.Ferrari@LUMC.NL
Lancet (London, England)
|December 1, 2001
概括
口服的三平坦是有效的急性偏头痛治疗方法. 高剂量的瑞扎特里普坦,埃莱特里普坦和阿尔莫特里普坦为持续的偏头痛缓解提供了最佳机会,并且耐受性很好.
科学领域:
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 三类药物是选择性的血清素5-HT ((1B/1D) 激动剂,被认为是对偏头痛的有效急性治疗方法.
- 由于即将有七种三胺配方的可用性,因此需要基于证据的临床选择指南.
- 标准化试验设计有助于对实际临床指导进行元分析.
研究的目的:
- 进行口服普坦临床试验的元分析,以建立基于证据的选择准则.
- 基于汇总的患者数据,比较各种口服平剂的疗效和耐受性.
主要方法:
- 从制药公司和独立研究人员获取所有相关试验的数据.
- 在偏头痛患者中对口服三药进行双盲,随机,受控试验的元分析.
- 计算有效性和耐受性参数的总结估计,包括直接比较试验.
主要成果:
- 包括53项试验 (12项未发表) 与24,089名患者.
- 苏马特里普坦 (100毫克) 在2小时内显示了59%的头痛反应和29%的无疼痛率.
- 与苏马特里普坦相比,利萨特里普坦 (10 mg) 和电力特里普坦 (80 mg) 显示出更高的疗效和一致性,而阿尔莫特里普坦 (12.5 mg) 显示出可比的2小时疗效.
- 在三类药物中,不良事件发生率一般较低,尽管电力三 (80毫克) 的耐受性较低.
结论:
- 所有口服的三抗都是有效的,并且在市场上销售的剂量下耐受良好.
- 利扎特里普坦 (10毫克),埃莱特里普坦 (80毫克) 和阿尔莫特里普坦 (12.5毫克) 提供了持续偏头痛治疗成功的最高概率.
相关概念视频
Drugs Affecting Neurotransmitter Release or Uptake
Certain drugs can affect how neurotransmitters called catecholamines, are released or taken back up in the adrenergic neuron. They can have different effects on the body's sympathetic transmission. Reserpine, a natural compound found in the Rauwolfia shrub, blocks a transporter called vesicular monoamine transporter (VMAT), which leads to a buildup of catecholamines in the cell and reduces sympathetic transmission. Another drug called guanethidine works in multiple ways, including blocking...
Antidepressant Drugs: Overview
Antidepressant drugs are a class of medications primarily used for treating various mood disorders, including major depression, anxiety disorders, and other related conditions. These medicines work by modulating the neurotransmitter balance within the brain, alleviating depressive symptoms. Antidepressants can be broadly categorized into several groups according to their mechanism of action and chemical structure: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine...
Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs
Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
Antidepressant Drugs: MAOIs and Other Agents
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists
Serotonin, a crucial neurotransmitter synthesized by enterochromaffin cells, plays a cardinal role in regulating gastrointestinal (GI) motility. With over 90% of the body's total serotonin in the GI tract, its influence on digestive processes is profound. Serotonin is swiftly released upon various stimuli, such as food boluses or certain drugs, triggering intrinsic sensory neurons in the myenteric plexus and extrinsic vagal and spinal sensory neurons. This leads to the activation of the...
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...


