The efficacy of dexketoprofen for migraine attack: A meta-analysis of randomized controlled studies

Baohua Yang, Zhili Xu, Linglong Chen, Xinguo Chen, Yuequn Xie, Baohua Yang, Zhili Xu, Linglong Chen, Xinguo Chen, Yuequn Xie

Abstract

Background: The efficacy of dexketoprofen for migraine attack remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexketoprofen supplementation versus placebo on pain control in migraine attack patients.

Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through March 2019 for randomized controlled trials (RCTs) assessing the effect of dexketoprofen supplementation versus placebo on pain control for migraine attack patients. This meta-analysis is performed using the random-effect model.

Results: Five RCTs involving 794 patients are included in the meta-analysis. Overall, compared with control group for migraine attack, dexketoprofen supplementation is associated with substantially increased pain free at 2 hours (RR = 1.90; 95% CI = 1.43-2.53; P < .0001), pain free at 48 hours (RR = 1.63; 95% CI = 1.07-2.49; P = .02), good or excellent treatment (RR = 1.48; 95% CI = 1.24-1.78; P < .0001) and pain relief at 2 hours (RR = 1.80; 95% CI = 1.17-2.77; P = .007), as well as reduced need for rescue drug (RR = 0.64; 95% CI = 0.43-0.94; P = .02), with no significant increase in adverse events (RR = 1.51; 95% CI = 0.87-2.62; P = .14).

Conclusion: Dexketoprofen supplementation benefits to improve pain control at 48 hours and reduce the need for rescue drug in migraine attack patients.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of study searching and selection process.
Figure 2
Figure 2
Forest plot for the meta-analysis of pain free at 2 hours.
Figure 3
Figure 3
Funnel plot for the outcome of pain free at 2 hours.
Figure 4
Figure 4
Forest plot for the meta-analysis of pain free at 48 hours.
Figure 5
Figure 5
Forest plot for the meta-analysis of good or excellent treatment.
Figure 6
Figure 6
Forest plot for the meta-analysis of pain relief at 2 hours.
Figure 7
Figure 7
Forest plot for the meta-analysis of the need for rescue drug.
Figure 8
Figure 8
Forest plot for the meta-analysis of adverse events.

References

    1. MacGregor EA. Migraine. Ann Int Med 2017;166:ITC49–64.
    1. Tepper SJ, Diener HC, Ashina M, et al. Erenumab in chronic migraine with medication overuse: subgroup analysis of a randomized trial. Neurology 2019;92:e2309–20.
    1. Golikhatir I, Cheraghmakani H, Bozorgi F, et al. The efficacy and safety of prochlorperazine in patients with acute migraine: a systematic review and meta-analysis. Headache 2019;59:682–700.
    1. Vinson DR. Treatment patterns of isolated benign headache in US emergency departments. Ann Emerg Med 2002;39:215–22.
    1. Maasumi K, Tepper SJ, Kriegler JS. Menstrual migraine and treatment options: review. Headache 2017;57:194–208.
    1. Hindiyeh NA, Kellerman DJ, Schmidt PC. Review of acute treatment of migraine trial results with the new FDA endpoints: design implications for future trials. Headache 2019;59:819–24.
    1. Lipton RB, Munjal S, Brand-Schieber E, et al. DFN-02, sumatriptan 10 mg nasal spray with permeation enhancer, for the acute treatment of migraine: a randomized, double-blind, placebo-controlled study assessing functional disability and subject satisfaction with treatment. CNS Drugs 2019;33:375–82.
    1. Derry CJ, Derry S, Moore RA. Sumatriptan (all routes of administration) for acute migraine attacks in adults – overview of Cochrane reviews. Cochrane Database Syst Rev 2014;CD009108.
    1. Derry S, Rabbie R, Moore RA. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev 2013;CD008783.
    1. Vollesen ALH, Ashina M. PACAP38: emerging drug target in migraine and cluster headache. Headache 2017;57Suppl 2:56–63.
    1. Etchison AR, Bos L, Ray M, et al. Low-dose ketamine does not improve migraine in the emergency department: a randomized placebo-controlled trial. West J Emerg Med 2018;19:952–60.
    1. Allais G, De Lorenzo C, Airola G, et al. Dexketoprofen trometamol in the treatment of acute migraine attack. Minerva Med 2000;91:153–9.
    1. Caldwell J, Hutt AJ, Fournel-Gigleux S. The metabolic chiral inversion and dispositional enantioselectivity of the 2-arylpropionic acids and their biological consequences. Biochem Pharmacol 1988;37:105–14.
    1. Tullo V, Valguarnera F, Barbanti P, et al. Comparison of frovatriptan plus dexketoprofen (25 mg or 37.5 mg) with frovatriptan alone in the treatment of migraine attacks with or without aura: a randomized study. Cephalalgia 2014;34:434–45.
    1. Gungor F, Akyol KC, Kesapli M, et al. Intravenous dexketoprofen vs placebo for migraine attack in the emergency department: a randomized, placebo-controlled trial. Cephalalgia 2016;36:179–84.
    1. Allais G, Bussone G, Tullo V, et al. Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial. Cephalalgia 2015;35:45–50.
    1. Mainardi F, Maggioni F, Pezzola D, et al. Dexketoprofen trometamol in the acute treatment of migraine attack: a phase II, randomized, double-blind, crossover, placebo-controlled, dose optimization study. J Pain 2014;15:388–94.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;6:b2535.
    1. The Cochrane Collaboration, Higgins J, Thomas J. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. 2011.
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–2.
    1. Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001;135:982–9.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–58.
    1. Allais G, Tullo V, Cortelli P, et al. Efficacy of early vs. late use of frovatriptan combined with dexketoprofen vs. frovatriptan alone in the acute treatment of migraine attacks with or without aura. Neurol Sci 2014;35Suppl 1:107–13.
    1. Kacperski J, Hershey AD. Newly approved agents for the treatment and prevention of pediatric migraine. CNS Drugs 2016;30:837–44.
    1. Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci 2012;39:S1–59.
    1. Tfelt-Hansen P, Pascual J, Ramadan N, et al. Guidelines for controlled trials of drugs in migraine: third edition. A guide for investigators. Cephalalgia 2012;32:6–38.
    1. Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. Eur J Neurol 2009;16:968–81.
    1. Balbisi EA. Frovatriptan succinate, a 5-HT1B/1D receptor agonist for migraine. Int J Clin Pract 2004;58:695–705.
    1. Savi L, Omboni S, Lisotto C, et al. A double-blind, randomized, multicenter, Italian study of frovatriptan versus rizatriptan for the acute treatment of migraine. J Headache Pain 2011;12:219–26.
    1. Bartolini M, Giamberardino MA, Lisotto C, et al. A double-blind, randomized, multicenter, Italian study of frovatriptan versus almotriptan for the acute treatment of migraine. J Headache Pain 2011;12:361–8.
    1. Cortelli P, Allais G, Tullo V, et al. Frovatriptan versus other triptans in the acute treatment of migraine: pooled analysis of three double-blind, randomized, cross-over, multicenter, Italian studies. Neurol Sci 2011;32Suppl 1:S95–8.

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