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Numthavaj P, Anothaisintawee T, Attia J, McKay G, Thakkinstian A. Efficacy of migraine prophylaxis treatments for treatment-naïve patients and those with prior treatment failure: a protocol for systematic review and network meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e077916. [PMID: 38431293 PMCID: PMC10910597 DOI: 10.1136/bmjopen-2023-077916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Migraine headache is a significant health problem affecting patients' psychological well-being and quality of life. Several network meta-analyses (NMAs) have compared the efficacy of migraine prophylaxis medications. However, some have focused exclusively on oral medications, while others were limited to injectable medications. Moreover, none of these NMAs conducted a stratified analysis between treatment-naïve patients and those with prior treatment failure. Therefore, this systematic review and NMA will compare the efficacy among all treatments for migraine prophylaxis, stratified by the treatment status of patients (ie, treatment-naïve and previous treatment failure). METHODS AND ANALYSIS Randomised-controlled trials that included patients with chronic or episodic migraine, assessed the efficacy of oral or injectable treatments for migraine prophylaxis and measured the outcomes as monthly migraine day, monthly headache day, migraine-related disability, health-related quality of life or adverse drug events will be eligible for inclusion in this review. Relevant studies will be searched from Medline, Scopus, the US National Institutes of Health Register, and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) databases since inception through 15 August 2023. Risk of bias assessment will be performed using a revised tool for assessing the risk of bias in randomised trials. Two-stage NMA will be applied to compare relative treatment effects among all treatments of migraine prophylaxis. Surface under the cumulative ranking curve will be applied to estimate and rank the probability to be the best treatment. Consistency assumption will be assessed using a design-by-treatment interaction model. Publication bias will be assessed by comparison-adjusted funnel plot. All analyses will be stratified according to patients' status (ie, treatment-naïve and prior treatment failure). ETHICS AND DISSEMINATION This study is a systematic review protocol collecting data from published literature and does not require approval from an institutional review board. Results from this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020171843.
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Affiliation(s)
- Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Diener HC, May A. New migraine drugs: A critical appraisal of the reason why the majority of migraine patients do not receive an adequate medication. Cephalalgia 2024; 44:3331024241228605. [PMID: 38520255 DOI: 10.1177/03331024241228605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
The last three decades have produced several novel and efficient medications to treat migraine attacks and reduce attack frequency. Additionally, promising approaches for the development of acute therapy and migraine prophylaxis continue to be pursued. At the same time as we witness the development of better and more efficient medications with continuously fewer side effects, we also realise that the high cost of such therapies means that only a minority of migraine patients who could benefit from these medications can afford them. Furthermore, information on cost-effectiveness is still lacking. Here, we compare availiable data, highlight open questions and suggest trials to close knowledge gaps. With good reason, our medicine is evidence-based. However, if this evidence is not collected, our decisions will continue to be based on marketing and assumptions. At the moment, we are not doing justice to our patients.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Arne May
- Department of Systems Neuroscience, University Hamburg, Hamburg, Germany
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3
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Moskatel LS, Zhang N. The Role of Step Therapy in the Treatment of Migraine. Curr Pain Headache Rep 2023; 27:571-577. [PMID: 37542597 DOI: 10.1007/s11916-023-01155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE OF REVIEW This review examines recent evidence and applies bioethical principles to evaluate the benefits and risks of using step therapy in the treatment of migraine. RECENT FINDINGS With the CGRP mAbs, gepants, and lasmiditan now on the market for up to 5 years, new research, including network meta-analyses and long-term use studies, can evaluate the comparative efficacy, tolerability, and adherence of these medications relative to older acute and preventive medications for the treatment of migraine. Deciding how medications are chosen for patients requires accounting for many factors including sustainability, efficacy, tolerability, and preference. Newer research can help give clarity on the appropriateness of gating certain treatment options behind others.
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Affiliation(s)
- Leon S Moskatel
- Division of Headache, Department of Neurology and Neurological Sciences, Stanford University, 211 Quarry Road, Suite #206, Palo Alto, CA, 94304, USA.
| | - Niushen Zhang
- Division of Headache, Department of Neurology and Neurological Sciences, Stanford University, 211 Quarry Road, Suite #206, Palo Alto, CA, 94304, USA
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George E, Straube A, Kamm K. [Migraine - diagnosis and prophylaxis]. MMW Fortschr Med 2023; 165:52-58. [PMID: 37759020 DOI: 10.1007/s15006-023-2884-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Elizabeth George
- Neurologische Klinik und -Poliklinik, LMU Klinikum Campus Großhadern, München, Deutschland
| | - Andreas Straube
- Neurologische Klinik / Oberbayer. Kopfschmerzzentrum, Klinikum Großhadern der LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Katharina Kamm
- - Neurolog. Klinik und Poliklinik -, Klinikum Großhadern d. LMU München, Marchioninistraße 15, 81377, München, Deutschland.
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5
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Malcangi G, Patano A, Guglielmo M, Sardano R, Palmieri G, Di Pede C, de Ruvo E, Inchingolo AD, Mancini A, Inchingolo F, Bordea IR, Dipalma G, Inchingolo AM. Precision Medicine in Oral Health and Diseases: A Systematic Review. J Pers Med 2023; 13:jpm13050725. [PMID: 37240895 DOI: 10.3390/jpm13050725] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Precision medicine (PM) is personalized medicine that can develop targeted medical therapies for the individual patient, in which "omics" sciences lead to an integration of data that leads to highly predictive models of the functioning of the individual biological system. They enable rapid diagnosis, assessment of disease dynamics, identification of targeted treatment protocols, and reduction of costs and psychological stress. "Precision dentistry" (DP) is one promising application that need further investigation; the purpose of this paper is therefore to give physicians an overview of the knowledge they need to enhance treatment planning and patient response to therapy. A systematic literature review was conducted on the PubMed, Scopus, and Web of Science databases by analyzing the articles examining the role of precision medicine in dentistry. PM aims to shed light on cancer prevention strategies, by identifying risk factors, and on malformations such as orofacial cleft. Another application is pain management by repurposing drugs created for other diseases to target biochemical mechanisms. The significant heritability of traits regulating bacterial colonization and local inflammatory responses is another result of genomic research, and is useful for DP in the field of caries and periodontitis. This approach may also be useful in the field of orthodontics and regenerative dentistry. The possibility of creating an international network of databases will lead to the diagnosis, prediction, and prevention of disease outbreaks, providing significant economic savings for the world's health care systems.
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Affiliation(s)
- Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | | | - Roberta Sardano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Giulia Palmieri
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Chiara Di Pede
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Elisabetta de Ruvo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | | | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
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Aksu S, Şirin TC, Hasırcı Bayır BR, Ulukan Ç, Soyata AZ, Kurt A, Karamürsel S, Baykan B. Long-Term Prophylactic Transcranial Direct Current Stimulation Ameliorates Allodynia and Improves Clinical Outcomes in Individuals With Migraine. Neuromodulation 2022:S1094-7159(22)00759-0. [DOI: 10.1016/j.neurom.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/27/2022] [Accepted: 06/28/2022] [Indexed: 10/15/2022]
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Sevivas H, Fresco P. Treatment of resistant chronic migraine with anti-CGRP monoclonal antibodies: a systematic review. Eur J Med Res 2022; 27:86. [PMID: 35659086 PMCID: PMC9167529 DOI: 10.1186/s40001-022-00716-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/15/2022] [Indexed: 01/26/2023] Open
Abstract
Background Resistant chronic migraine is a highly disabling condition which is very difficult to treat. The majority of the treatments for migraine prophylaxis are nonspecific and present weak safety profiles, leading to low adherence and discontinuation. Currently, monoclonal antibodies (mAb) targeting the trigeminal sensory neuropeptide, calcitonin gene-related peptide (CGRP), are available for migraine prophylaxis being the first drugs developed specifically to target migraine pathogenesis. The main objective of the current work is to carry out a systematic review of randomised controlled trials that specifically analyse the effectivity and safety of anti-CGRP mAb, comparatively to placebo, in patients with resistant chronic migraine and possibly fill the literature gap or be a source of information to health professionals. Additionally the current knowledge on migraine, particularly resistant chronic migraine, was revisited and summarised. Methods Literature search was carried out on MEDLINE, Scopus, Science Direct and ClinicalTrials.gov database, from inception to December 2021. Articles were selected according to prespecified criteria of inclusion and exclusion. Efficacy and safety outcomes included were: change from baseline in monthly migraine days (MMD); ≥50% reduction of MMD values from baseline; change from baseline in monthly acute migraine-specific medication days (MAMD); Migraine-specific Quality of Life Questionnaire (MSQ); and registered adverse events. Additionally, we used the Cochrane risk of bias tool (RoB 2) to assess the risk of bias of the included studies. Results Four studies were included in this systematic review, involving 2811 resistant chronic migraine patients, 667 in a study using erenumab, 838 in a study using fremanezumab and 1306 in two studies using galcanezumab. When compared to placebo, all investigated anti-CGRP mAb and respective doses demonstrate effectiveness in decreasing MMD, reducing acute medication use and improving the MSQ scores, including, sometimes, reversion of chronic to episodic migraine (efficacy outcomes). Regarding the safety outcomes, the number and type of adverse events did not differ between anti-CGRP mAb-treated and placebo groups. Conclusions Anti-CGRP or anti-CGRP receptor monoclonal antibodies are a promising preventive migraine therapy which can be particularly useful for resistant chronic migraine patients.
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Affiliation(s)
- Hugo Sevivas
- Faculdade de Medicina da Universidade Do Porto (FMUP), Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.
| | - Paula Fresco
- Laboratório de Farmacologia, Departamento de Ciências Do Medicamento, Faculdade de Farmácia da Universidade Do Porto (FFUP), Porto, Portugal.,I3S, Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
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Sico JJ, Macedo F, Lewis J, Spevak C, Vogsland R, Ford A, Skop K, Sall J. The Primary Care Management of Headache: Synopsis of the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Mil Med 2022; 187:e1091-e1102. [PMID: 35022782 DOI: 10.1093/milmed/usab490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/20/2021] [Accepted: 01/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache. METHODS In October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. RESULTS The guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. CONCLUSION This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.
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Affiliation(s)
- Jason J Sico
- Headache Centers of Excellence (HCoE) Program, National Programs Center, Orange, CT 06477, USA.,HCoE Research and Evaluation Center, Veterans Health Administration.,Department of Neurology (Headache Medicine and Vascular Neurology) and Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT 06520, USA.,VA Connecticut Healthcare System Department of Neurology, National Programs Center, Orange, CT 06477, USA
| | - Franz Macedo
- Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | - Jeffrey Lewis
- Wright-Patterson Air Force Base Mental Health Clinic, Wright-Patterson AFB, OH 45433, USA
| | - Christopher Spevak
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | | | - Aven Ford
- USAFSAM/FECN, Wright-Patterson AFB, OH 45433, USA
| | - Karen Skop
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - James Sall
- Quality and Patient Safety, Office of Evidence Based Practice, U.S. Department of Veterans Affairs, New Braunfels, TX 78132, USA.,Department of Clinical Anesthesia, Georgetown University School of Medicine.,Program Director Pain Fellowship, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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9
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Azimova Y, Amelin A, Alferova V, Artemenko A, Akhmadeeva L, Golovacheva V, Danilov A, Ekusheva E, Isagulian E, Koreshkina M, Kurushina O, Latysheva N, Lebedeva E, Naprienko M, Osipova V, Pavlov N, Parfenov V, Rachin A, Sergeev A, Skorobogatykh K, Tabeeva G, Filatova E. Clinical guidelines "Migraine". Zh Nevrol Psikhiatr Im S S Korsakova 2022. [DOI: 10.17116/jnevro20221220134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Jin B, Liu H, Qiao L. Unveiling the comparative efficacy and tolerability of comprehensive treatments for migraine: A protocol of systematic review and Bayesian network meta-analysis. Medicine (Baltimore) 2021; 100:e24083. [PMID: 33530202 PMCID: PMC7850759 DOI: 10.1097/md.0000000000024083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Migraine is a chronic paroxysmal incapacitating neurological disorder, which endangers the health of human worldwide ranking as the third most prevalent medical condition. There are no comprehensive estimates of treatments for migraine. We will conduct this systematic review and Bayesian network meta-analysis (NMA) to synthesis quantitative and comparative evidence on the efficacy and tolerability of all the known pharmacological and non-pharmacological interventions for migraine. METHOD We will perform the systematic electronic search of the literature utilizing MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing & Allied Health (CINAHL), and PsycINFO. We will only include randomized controlled trials (RCTs) of high quality which appraise the efficacy or safety of any potential pharmacological or non-pharmacological interventions in the treatment of patients with migraine. The traditional pairwise meta-analyses will be performed to anticipate the heterogeneities and publication bias and the NMA will be conducted within a Bayesian hierarchical model framework to obtain estimates for all valuable treatments for migraine. The entire heterogeneity will be quantified by Q statistic and I2 index. Other analyses included sensitivity analyses, meta-regression, and subgroup analyses will also be conducted. The whole process will be conducted using in R-3.6.0 software. RESULTS This study will obtain the efficacy and tolerability of all potential treatments for migraine, aiming at providing consolidated evidence to help make the best choice of interventions. The results will be published in a peer-reviewed journal. DISCUSSION This Bayesian network meta-analysis may be the first attempt to quantitatively synthesize the efficacy and tolerability of all potential treatments for migraine. And this method can ensure us to fully utilize both the direct and indirect evidence as well as gain the comparative estimates displayed in the derived hierarchies. Besides, we have registered this protocol on the international prospective register of systematic review (PROSPERO) (CRD42020157278).
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Affiliation(s)
- Boru Jin
- Department of Neurology, First Affiliated Hospital, China Medical University
| | - Huayan Liu
- Department of Neurology, First Affiliated Hospital, China Medical University
| | - Lei Qiao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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11
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Efficacy of levetiracetam for migraine prophylaxis: A systematic review and meta-analysis. J Formos Med Assoc 2021; 120:755-764. [DOI: 10.1016/j.jfma.2020.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022] Open
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Slade GD, Fillingim RB, Ohrbach R, Hadgraft H, Willis J, Arbes SJ, Tchivileva IE. COMT Genotype and Efficacy of Propranolol for TMD Pain: A Randomized Trial. J Dent Res 2020; 100:163-170. [PMID: 33030089 PMCID: PMC8163522 DOI: 10.1177/0022034520962733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Propranolol is a nonselective β-adrenergic receptor antagonist that is
efficacious in reducing facial pain. There is evidence that its analgesic
efficacy might be modified by variants of the catechol-O-methyltransferase
(COMT) gene. We tested the hypothesis in a subset of 143
non-Hispanic Whites from a randomized controlled trial of patients with painful
temporomandibular disorder (TMD). Patients were genotyped for rs4680, a single
nucleotide polymorphism of COMT, and randomly allocated to
either propranolol 60 mg twice daily or placebo. During the 9-wk follow-up
period, patients recorded daily ratings of facial pain intensity and duration;
the product was computed as an index of facial pain. Postbaseline change in the
index at week 9 (the primary endpoint) was analyzed as a continuous variable and
dichotomized at thresholds of ≥30% and ≥50% reduction. Mixed models for repeated
measures tested for the genotype × treatment group interaction and estimated
means, odds ratios (ORs), and 95% confidence limits (95% CLs) of efficacy within
COMT genotypes assuming an additive genetic model. In
secondary analysis, the cumulative response curves were plotted for dichotomized
reductions ranging from ≥20% to ≥70%, and genotype differences in area under the
curve percentages (%AUC) were calculated to signify efficacy. Mean index
reduction did not differ significantly (P = 0.277) according to
genotype, whereas the dichotomized ≥30% reduction revealed greater efficacy
among G:G homozygotes (OR = 10.9, 95%CL = 2.4, 50.7) than among A:A homozygotes
(OR = 0.8, 95%CL = 0.2, 3.2) with statistically significant interaction
(P = 0.035). Cumulative response curves confirmed greater
(P = 0.003) efficacy for G:G homozygotes (%AUC difference =
43.7, 95%CL = 15.4, 72.1) than for A:A homozygotes (%AUC difference = 6.5, 95%CL
= -30.2, 43.2). The observed antagonistic effect of the A allele on
propranolol’s efficacy was opposite the synergistic effect hypothesized a
priori. This unexpected result highlights the need for better knowledge of
COMT’s role in pain pathogenesis if the gene is to be used
for precision-medicine treatment of TMD (ClinicalTrials.gov NCT02437383).
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Affiliation(s)
- G D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - R Ohrbach
- Department of Oral and Maxillofacial Surgery, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | | | | | - I E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Evans K, Romero H, Spierings EL, Katz N. The relation between the placebo response, observed treatment effect, and failure to meet primary endpoint: A systematic review of clinical trials of preventative pharmacological migraine treatments. Cephalalgia 2020; 41:247-255. [PMID: 32960658 DOI: 10.1177/0333102420960020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the association between the degree of response to placebo in migraine studies and the observed difference between drug and placebo across studies of preventative treatments for migraine. METHODS A systematic review was performed using MEDLINE and the Cochrane Central Register of Controlled Clinical Trials from January 1988 to June 2019. Randomized, double-blind, parallel-group, placebo-controlled trials on oral or injection preventative treatments for migraine were included. Single- and multi-variable linear regression analyses were performed on the placebo-subtracted response rate (i.e. placebo responders subtracted from active responders), and the proportion of placebo responders. Fisher's exact tests were performed on the level of placebo response and the success in meeting the study's primary endpoint. RESULTS After adjusting for route of administration and number of randomized subjects, there was a statistically significant association between the proportion of patients who were placebo responders and the placebo-subtracted response rate (b = -0.27, p = 0.02). There was a statistically significant difference in trial success rate (60%) between studies with ≤20% placebo responders and studies with > 30% placebo responders (p = 0.03). CONCLUSION Considering the detrimental impact that high placebo response can have on clinical trials, it is imperative to find effective solutions to decrease the placebo response and increase assay sensitivity.
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Affiliation(s)
| | | | | | - Nathaniel Katz
- WCG Analgesic Solutions, Wayland, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
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Filatova EG, Osipova VV, Tabeeva GR, Parfenov VA, Ekusheva EV, Azimova YE, Latysheva NV, Naprienko MV, Skorobogatykh KV, Sergeev AV, Golovacheva VA, Lebedeva ER, Artyomenko AR, Kurushina OV, Koreshkina MI, Amelin AV, Akhmadeeva LR, Rachin AR, Isagulyan ED, Danilov AB, Gekht AB. Diagnosis and treatment of migraine: Russian experts' recommendations. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2020. [DOI: 10.14412/2074-2711-2020-4-4-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).
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Affiliation(s)
- E. G. Filatova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. V. Osipova
- Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department; University Headache Clinic
| | - G. R. Tabeeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. A. Parfenov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - E. V. Ekusheva
- Academy of Postgraduate Education «Federal Research and Clinical Center for Specialized Medical Care Types and Medical Technologies, Federal Biomedical Agency of Russia»
| | | | - N. V. Latysheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - M. V. Naprienko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | | | - A. V. Sergeev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. A. Golovacheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - E. R. Lebedeva
- Ural State Medical University, Ministry of Health of Russia
| | - A. R. Artyomenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - O. V. Kurushina
- Volgograd State Medical University, Ministry of Health of Russia
| | | | - A. V. Amelin
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | | | - A. R. Rachin
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia
| | - E. D. Isagulyan
- Academician N.N. Burdenko National Medical Research Center of Neurosurgery
| | - Al. B. Danilov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - A. B. Gekht
- Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department
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15
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Parikh SK, Delbono MV, Silberstein SD. Managing migraine in pregnancy and breastfeeding. PROGRESS IN BRAIN RESEARCH 2020; 255:275-309. [PMID: 33008509 DOI: 10.1016/bs.pbr.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
The disproportionate prevalence of migraine among women in their reproductive years underscores the clinical significance of migraine during pregnancy. This paper discusses how migraine evolves during pregnancy, secondary headache disorders presenting in pregnancy and puerperium, and acute and preventive options for migraine management during pregnancy and lactation. Migraine is influenced by rising estrogen levels during pregnancy and their sharp decline in puerperium. Migraine, and migraine aura, can present for the first time during pregnancy and puerperium. There is also a higher risk for the development of preeclampsia and cerebrovascular headache during these periods. New or refractory headache, hypertension, and abnormal neurological signs are important "red flags" to consider. This paper reviews the diagnostic utility of neuroimaging studies and the risks of each during pregnancy. Untreated migraine can itself lead to preterm delivery, preeclampsia, and low birth weight infants. Behavioral interventions and lifestyle modifications are the cornerstone for migraine treatment during pregnancy. In addition, one should consider the risks and efficacy of each treatment during pregnancy on an individual basis. The protective nature of breastfeeding for migraine is debated, but there is no evidence to suggest breastfeeding worsens migraine. Acute and preventive migraine treatment options are available for nursing mothers. Neuromodulation and neurostimulation devices are additional options for treatment during pregnancy and lactation, while the safety of using calcitonin gene-related peptide receptor antagonists during these times remains to be determined.
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Affiliation(s)
- Simy K Parikh
- Thomas Jefferson University, Philadelphia, PA, United States
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VanderEnde J, Bateman EA, MacKenzie HM, Sequeira K. Use of CGRP receptor blocker erenumab in the management of post-traumatic headache: a case series of 5 women. Brain Inj 2020; 34:1431-1434. [PMID: 32790533 DOI: 10.1080/02699052.2020.1807052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Post-traumatic headache (PTH) is a disabling headache disorder and the most common sequela of mild traumatic brain injury. The pathophysiology of PTH is poorly understood and there is limited available evidence to guide prophylactic medication selection. Emerging understanding of the pathophysiology of migraine headaches has led to the development of monoclonal antibodies, including erenumab. Erenumab has shown promise for the prevention of primary migraine headache; however, it has not yet been studied in PTH. CASE SERIES five women (average age 43.0 ± 17.9y) received treatment with erenumab for PTH secondary to mTBI. The average duration of PTH prior to starting erenumab was 32.0 ± 18.2 months. All patients were taking at least one daily headache prophylactic therapy prior to erenumab. The average pre-erenumab headache intensity was 86/100. On erenumab, the average reported reduction in headache intensity was 51.1%. After starting erenumab, all five patients were able to discontinue one or more medication(s). The most common side effect was constipation (three patients). There were no serious adverse events after an average follow-up of 3.4 ± 1.5 months. One patient discontinued erenumab during this period of follow-up after the resolution of her headaches. CONCLUSION Erenumab appears to be safe and effective for the management of PTH.
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Affiliation(s)
- Jordan VanderEnde
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
| | - Emma A Bateman
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
| | - Heather M MacKenzie
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
| | - Keith Sequeira
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
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17
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Zernikow B. Can We Really Stop Pediatric Migraine?: Using Network Meta-analysis to Remove the Guess Work. JAMA Pediatr 2020; 174:325-326. [PMID: 32040138 DOI: 10.1001/jamapediatrics.2019.5907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Boris Zernikow
- Children's and Adolescents' Hospital Datteln, Witten/Herdecke University, German Paediatric Pain Centre, Datteln, North Rhine-Westphalia, Germany
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18
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Levetiracetam as preventive treatment in adults with migraine: an up-to-date systematic review and quantitative meta-analysis. Eur J Clin Pharmacol 2019; 76:161-174. [DOI: 10.1007/s00228-019-02790-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/25/2019] [Indexed: 01/21/2023]
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Abstract
Propranolol is a beta-adrenergic receptor antagonist that was developed by the British scientist Sir James Black primarily for the treatment of angina pectoris, more than 50 years ago. It was not long before several other cardiovascular as well as noncardiovascular therapeutic uses of propranolol were discovered. Propranolol soon became a powerful tool for physicians in the treatment of numerous conditions such as hypertension, cardiac arrhythmias, myocardial infarction, migraine, portal hypertension, anxiety, essential tremors, hyperthyroidism, and pheochromocytoma. Owing to its action at multiple receptor sites, propranolol exerts several central and peripheral effects and is therefore useful in various conditions. Right from reduction in postmyocardial mortality to control of anxiety in performers, propranolol plays an important role in a plethora of medical conditions. Interestingly, even today, newer indications of this age-old drug are being discovered. Moreover, propranolol treatment has been found to be cost-effective when compared to other corresponding treatment options for individual indications. In this article, we attempt to recount the journey of propranolol right from its inception to the present day.
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Affiliation(s)
- A. V. Srinivasan
- Former Professor of Neurology and Head - Institute of Neurology, Madras Medical College, Chennai, Emeritus Professor - The Tamil Nadu Dr. M.G.R. Medical University, Adjunct Professor - Indian Institute of Technology (IIT - Chennai), Tamil Nadu, India
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20
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Chelimsky G, Chelimsky T. The gastrointestinal symptoms present in patients with postural tachycardia syndrome: A review of the literature and overview of treatment. Auton Neurosci 2018; 215:70-77. [PMID: 30245098 DOI: 10.1016/j.autneu.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022]
Abstract
Orthostatic intolerance, including postural tachycardia syndrome, is often associated with gastrointestinal symptoms. In the vast majority of the cases, the gastrointestinal symptoms are not secondary to the orthostatic disorder, but rather just a comorbid condition. This concept is critical, since treatment aimed at the orthostatic condition will not improve the gastrointestinal symptoms. Only when the gastrointestinal symptoms develop in the upright position and improve or resolve in the supine position, they may be related to the orthostatic stress. The most common symptoms associated with orthostatic intolerance include nausea, dyspepsia, bloating and constipation. The majority of subjects do not have gastroparesis. The chapter discusses available treatments of these conditions.
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Affiliation(s)
- Gisela Chelimsky
- Department of Pediatrics, Division of Pediatric Gastroenterology, Medical College of Wisconsin, United States of America.
| | - Thomas Chelimsky
- Department of Neurology; Medical College of Wisconsin, United States of America
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21
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Magalhães JE, Sampaio Rocha-Filho PA. Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations. Headache 2018; 58:1277-1286. [DOI: 10.1111/head.13378] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/24/2023]
Affiliation(s)
- João Eudes Magalhães
- Postgraduate program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco (UFPE); Pernambuco Brazil
- Stroke Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Department of Neuropsychiatry; Universidade Federal de Pernambuco (UFPE); Recife Brazil
- Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
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22
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Cottier KE, Galloway EA, Calabrese EC, Tome ME, Liktor-Busa E, Kim J, Davis TP, Vanderah TW, Largent-Milnes TM. Loss of Blood-Brain Barrier Integrity in a KCl-Induced Model of Episodic Headache Enhances CNS Drug Delivery. eNeuro 2018; 5:ENEURO.0116-18.2018. [PMID: 30073201 PMCID: PMC6071204 DOI: 10.1523/eneuro.0116-18.2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/29/2018] [Accepted: 06/25/2018] [Indexed: 01/03/2023] Open
Abstract
Cortical spreading depression (CSD) in the CNS is suggested as a common mechanism contributing to headache. Despite strong evidence for CNS involvement in headache disorders, drug development for headache disorders remains focused on peripheral targets. Difficulty in delivering drugs across the blood-brain barrier (BBB) may partially account for this disparity. It is known, however, that BBB permeability is increased during several CNS pathologies. In this study, we investigated BBB changes in response to KCl-induced CSD events and subsequent allodynia in rats. Cortical KCl injection in awake, freely moving rats produced facial allodynia with peak intensity between 1.5 and 3 h and CSD induction within 0.5-2 h postinjection. Brain perfusion of 14C-sucrose as a marker of BBB paracellular permeability revealed increased leak in the cortex, but not brainstem, beginning 0.5 h post-KCl injection and resolving within 6 h; no changes in tight junction (TJ) proteins occludin or claudin-5 expression were observed. Acute pretreatment with topiramate to inhibit CSD did not prevent the increased BBB paracellular permeability. CNS delivery of the abortive anti-migraine agent sumatriptan was increased in the cortex 1.5 h post-KCl injection. Surprisingly, sumatriptan uptake was also increased in the brainstem following CSD induction, suggesting regulation of active transport mechanisms at the BBB. Together, these results demonstrate the ability of CSD events to produce transient, time-dependent changes in BBB permeability when allodynia is present and to mediate access of clinically relevant therapeutics (i.e., sumatriptan) to the CNS.
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Affiliation(s)
- Karissa E. Cottier
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - Emily A. Galloway
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - Elisa C. Calabrese
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - Margaret E. Tome
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - Erika Liktor-Busa
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - John Kim
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - Thomas P. Davis
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
| | - Todd W. Vanderah
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724
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24
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Liu D, Peng H, Sun Q, Zhao Z, Yu X, Ge S, Wang H, Fang H, Gao Q, Liu J, Wu L, Song M, Wang Y. The Indirect Efficacy Comparison of DNA Methylation in Sputum for Early Screening and Auxiliary Detection of Lung Cancer: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017. [PMID: 28644424 PMCID: PMC5551117 DOI: 10.3390/ijerph14070679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: DNA methylation in sputum has been an attractive candidate biomarker for the non-invasive screening and detection of lung cancer. Materials and Methods: Databases including PubMed, Ovid, Cochrane library, Web of Science databases, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang, Vip Databases and Google Scholar were searched to collect the diagnostic trials on aberrant DNA methylation in the screening and detection of lung cancer published until 1 December 2016. Indirect comparison meta-analysis was used to evaluate the diagnostic value of the included candidate genes. Results: The systematic literature search yielded a total of 33 studies including a total of 4801 subjects (2238 patients with lung cancer and 2563 controls) and covering 32 genes. We identified that methylated genes in sputum samples for the early screening and auxiliary detection of lung cancer yielded an overall sensitivity of 0.46 (0.41–0.50) and specificity of 0.83 (0.80–0.86). Combined indirect comparisons identified the superior gene of SOX17 (sensitivity: 0.84, specificity: 0.88), CDO1 (sensitivity: 0.78, specificity: 0.67), ZFP42 (sensitivity: 0.87, specificity: 0.63) and TAC1 (sensitivity: 0.86, specificity: 0.75). Conclusions: The present meta-analysis demonstrates that methylated SOX17, CDO1, ZFP42, TAC1, FAM19A4, FHIT, MGMT, p16, and RASSF1A are potential superior biomarkers for the screening and auxiliary detection of lung cancer.
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Affiliation(s)
- Di Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Hongli Peng
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Qi Sun
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Zhongyao Zhao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Xinwei Yu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
- School of Medical and Health Sciences, Edith Cowan University, Perth 6027, Australia.
| | - Siqi Ge
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
- School of Medical and Health Sciences, Edith Cowan University, Perth 6027, Australia.
| | - Hao Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Honghong Fang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Qing Gao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Jiaonan Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Lijuan Wu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Manshu Song
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Youxin Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China.
- School of Medical and Health Sciences, Edith Cowan University, Perth 6027, Australia.
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