Safety and efficacy of topiramate in migraine prophylaxis in younger patients: a meta-analysis
Abstract
Background: Prophylactic treatment of migraine using the AMPA (amino-3-hydroxy-5-methyl-4-isoxazolepropionic) receptor-blocking anticonvulsant Topiramate is associated with adverse events and questionable efficacy in youngers. The combination with adjunctive vitamin D3 is discussed to be more efficient and safer in younger patients with migraine. Objective: Compare the safety and efficacy of Topiramate alone or in combination with vitamin D3 versus placebo in the prophylaxis of migraine in younger patients. Methods: PUBMED, Scopus, and Web of Science for randomized controlled trials assessing the safety and efficacy of topiramate in younger patients for migraine prevention, alone or with vitamin D. Data were analyzed using Mantel-Haenszel statistics with 95% confidence intervals. Patients older than 18 years were excluded. Statistical analysis was performed using R version 4.3.2. Results: We included 6 RCTs comprising 653 patients, of which 306 underwent isolated use of Topiramate 100mg and 234 received a placebo. The subgroup analysis of Topiramate (2mg/kg/day) plus adjunctive vitamin D3 (daily dose 5,000 IU daily or 500,000 IU weekly doses) encompassed 57 patients receiving the combination treatment and 56 receiving a placebo. The topiramate therapy in association with vitamin D3 demonstrated a statistically significant difference in reducing migraine frequency (MD -3.66; 95% CI -4.33 to -2.98; P< 0.000001; I²=0), while topiramate alone did not show any difference in…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 653 participants or records.
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