Профилактика мигрени симвастатином и витамином D3

Вот интересные результаты исследования:

Симвастатин 20 мг раз в день плюс витамин D3 1000 международных единиц два раза в день при применении в течение 12-24 недель уменьшали в рандомизированном плацебо-контролированном исследовании частоту приступов мигрени почти в два раза.

Ссылка на новость:

Novel Drug Combination Prevents Migraine

Текст новости:

Most guideline-recommended drugs for preventing migraine are only moderately effective and have substantial side effects (Neurology 2012; 78:1337). In this study, researchers in Boston tested a novel drug combination for migraine prophylaxis — simvastatin plus vitamin D. The idea came from two observations: First, because migraine is associated with excess risk for vascular disorders, propensity to migraine might be reduced by statins, which improve endothelial function. Second, in a recent observational study, statin use was associated with lower prevalence of “severe headache or migraine” in people with higher serum vitamin D levels (Cephalalgia 2015; 35:757).

Fifty-seven adults with episodic migraine (4–14 migraine days per month) were randomized to simvastatin (20 mg twice daily) plus vitamin D₃ (1000 IU twice daily) or to double placebo. During the first 3 months of treatment, the median number of migraine days decreased by 8 with active therapy and increased by 1 with placebo (P<0.001). Findings were similar during months 4 through 6. The proportions of patients with ≥50% reduction in migraine days during months 4 to 6 were 29% with active treatment and 3% with placebo treatment (P=0.03). Side effects were negligible, and blinding was successful (according to standardized methods to assess blinding).

Comment

These results — showing that a well-tolerated drug combination was reasonably effective for migraine prevention — are quite eye-catching. However, the authors themselves call for replication of their findings in a larger population.

Оригинальная статья:

Buettner C et al. Simvastatin and vitamin D for migraine prevention: A randomized, controlled trial. Ann Neurol 2015 Dec; 78:970. (http://dx.doi.org/10.1002/ana.24534)

Acute Heart Failure: Current Standards and Evolution of Care

Для желающих подучиться (на английском языке):

http://www.clinicaloptions.com/Cardiology/Treatment...

Стандарты помощи при острой сердечной недостаточости.

Последние направления в лечении ВИЧ

Интересная обзорная статья в бесплатном доступе.

http://www.biomedcentral.com/1741-7015/13/284

Клопидогрель и аспирин при постоперационной мигрени

Вот тут описывают, что клопидогрель в комбинации с аспирином эффективнее чем аспирин в монотерапии уменьшает частоту и (значительно) интенсивность мигренозных приступов после кардиохирургического вмешательства.

Effect of Clopidogrel and Aspirin vs Aspirin Alone on Migraine Headaches After Transcatheter Atrial Septal Defect Closure

Importance  The occurrence of new-onset migraine attacks is a complication of transcatheter atrial septal defect (ASD) closure. It has been suggested that clopidogrel may reduce migraine attacks after ASD closure.

Objective  To assess the efficacy of clopidogrel, used in addition to taking aspirin, for the prevention of migraine attacks following ASD closure.

Design, Setting, and Participants  Randomized, double-blind clinical trial performed in 6 university hospitals in Canada. Participants were 171 patients with an indication for ASD closure and no history of migraine.

Interventions  Patients were randomized (1:1) to receive dual antiplatelet therapy (aspirin + clopidogrel [the clopidogrel group], n = 84) vs single antiplatelet therapy (aspirin + placebo [the placebo group], n = 87) for 3 months following transcatheter ASD closure. The first patient was enrolled in December 2008, and the last follow-up was completed in February 2015.

Main Outcomes and Measures  The primary efficacy outcome was the monthly number of migraine days within the 3 months following ASD closure in the entire study population. The incidence and severity of new-onset migraine attacks, as evaluated by the Migraine Disability Assessment questionnaire, were prespecified secondary end points. A zero-inflated Poisson regression model was used for data analysis.

Results  The mean (SD) age of the participants was 49 (15) years and 62% (106) were women. Patients in the clopidogrel group had a reduced mean (SD) number of monthly migraine days within the 3 months following the procedure (0.4 [95% CI, 0.07 to 0.69] days) vs the placebo group (1.4 [95% CI, 0.54 to 2.26] days; difference, −1.02 days [95% CI, −1.94 to −0.10 days]; incident risk ratio [IRR], 0.61 [95% CI, 0.41 to 0.91]; P = .04) and a lower incidence of migraine attacks following ASD closure (9.5% for the clopidogrel group vs 21.8% for the placebo group; difference, −12.3% [95% CI, −23% to −1.6%]; odds ratio [OR], 0.38 [95% CI, 0.15 to 0.89]; P = .03). Among patients with migraines, those in the clopidogrel group had less-severe migraine attacks (zero patients with moderately or severely disabling migraine attacks vs 37% [7 patients] in the placebo group; difference, −36.8% [95% CI, −58.5% to −15.2%]; P = .046). There were no between-group differences in the rate of patients with at least 1 adverse event (16.7% [14 patients] in the clopidogrel group vs 21.8% [19 patients] in the placebo group; difference, −5.2% [95% CI, −17% to 6.6%]; P = .44).

Conclusions and Relevance  Among patients who underwent transcatheter ASD closure, the use of clopidogrel and aspirin, compared with aspirin alone, resulted in a lower monthly frequency of migraine attacks over 3 months. Further studies are needed to assess generalizability and durability of this effect.

Trial Registration  clinicaltrials.gov Identifier:NCT00799045

This randomized trial of patients who had no history of migraines compared incidence of migraine attacks between those who used aspirin plus clopidogrel vs aspirin plus placebo for 3 months after undergoing transcatheter atrial septal defect closure.

Ссылка на pdf: http://jama.jamanetwork.com/data/Journals/JAMA/0/joi150131.pdf

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