TOPLINE:
For sufferers with migraine who consult with the emergency division (ED), intravenous (IV) chlorpromazine supplies awesome ache aid at 2 hours and IV metoclopramide mixtures are efficient in averting rescue drugs, a Bayesian community meta-analysis suggests.
METHODOLOGY:
- Researchers carried out a scientific evaluate and Bayesian community meta-analysis of 64 randomized managed trials from MEDLINE, Embase, and Internet of Science databases from inception to February 9, 2024.
- The evaluation integrated grownup contributors presenting to EDs with migraine, and pharmacologic remedies have been in comparison with every different or to a placebo.
- Number one results have been good enough ache aid at 2 hours, alternate in ache depth at 1 hour, want for rescue drug at 2 hours, and critical opposed reactions.
- Researchers used floor below the cumulative rating curve (SUCRA) to rank healing brokers.
TAKEAWAY:
- Chlorpromazine IV/intramuscular (IM) demonstrated the perfect likelihood of superiority (SUCRA, 87.3%) for good enough ache aid at 2 hours, adopted by means of prochlorperazine IV/IM (80.99%), and propofol (68.54%). Ibuprofen IV was once least efficient (2.47%).
- The metoclopramide IV-ibuprofen IV mixture confirmed the perfect chance of superiority for combating want for rescue drug (SUCRA, 94.6%), adopted by means of metoclopramide IV-dexketoprofen IV (85.53%), and chlorpromazine IV/IM (83.30%). Valproate IV was once least efficient (7.69%).
- Dexamethasone IV (SUCRA, 79.51%) emerged as possibly awesome for averting vital opposed reactions, adopted by means of ketorolac IV (79.37%).
- Researchers discovered vital inconsistencies within the information for ache depth adjustments at 1 hour, making the consequences unreliable and now not acceptable to broader settings.
IN PRACTICE:
“Chlorpromazine IV/IM is unquestionably amongst among the best, valproate IV is unquestionably some of the least efficient, and ketorolac IV/IM is in all probability some of the least efficient as unmarried brokers obviating the will for rescue drug,” the authors wrote. “The relative protection of the pharmacologic remedies can’t be made up our minds with enough walk in the park. Additional, randomized managed trials of parenterally administered, and most likely extra reasonably efficient pharmacologic remedies similar to chlorpromazine, prochlorperazine, and metoclopramide-NSAID [non-steroidal anti-inflammatory drug] mixtures will have to extra robustly identify that are the most productive choices for migraine within the ED,” they added.
SOURCE:
The learn about was once led by means of Ian S. deSouza, MD, SUNY Downstate Well being Sciences College and Kings County Sanatorium Heart, New York Town. It was once published online on December 13, 2024, in Annals of Emergency Medication.
LIMITATIONS:
The inclusion of an intravenous crystalloid bolus in some research could have diminished ache depth in clinically dehydrated contributors, doubtlessly inflating the impact estimates for those interventions. Medical heterogeneity, similar to variations in migraine kind, player demographics, and ranging inclusion standards, challenged the transitivity assumption within the community meta-analysis. Attainable overrepresentation of the subgroup with reasonable to critical ache could have skewed the entire effectiveness estimates, making the findings much less generalizable to a broader inhabitants with various ache ranges.
DISCLOSURES:
The authors declared that the learn about didn’t obtain any explicit investment. One writer disclosed being at the audio system bureau and serving as a expert for AstraZeneca.
This newsletter was once created the use of a number of editorial gear, together with AI, as a part of the method. Human editors reviewed this content material prior to e-newsletter.
