oral triptans (serotonin 5-ht 1b/1d agonists) in acute migraine treatment: a meta-analysis of 53...
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Oral triptans (serotonin 5-HT1B/1D
agonists) in acute migraine treatment: A meta-analysis of 53 trials
by Michel D. Ferrari, Krista I. Roon, Richard B. Lipton, Peter J. Goadsby
(Lancet 2001;358:1668-1675)
0 20 40 60 8050 7010 30 90 100
What Patients WantWhat Patients WantFrom Migraine Drug TherapyFrom Migraine Drug Therapy
Adapted from Lipton RB et al. Headache 1999;39(suppl 2):S20-S26.*Most commonly selected as important or very important.
% Migraineurs reporting each attribute (n=688)
No recurrence*
Rapid onset*
No side effects
Relief of associated symptoms
Route of administration
Complete pain relief* 87%
86%
83%
79%
76%
56%
Triptan Meta-Analysis:Triptan Meta-Analysis:BackgroundBackground
Objective• To evaluate the available clinical trial evidence base for oral
triptan (5HT1B/1D agonist) drugs and provide a foundation for their use in managing acute migraine.
Background• Given that seven different triptans are clinically available,
physicians need evidence-based guidelines to select the triptans with the highest likelihood of success.
Methods• Clinical trial databases for randomized and active-controlled
studies provided by manufacturers of rizatriptan, sumatriptan, zolmitriptan, eletriptan, almotriptan, and naratriptan.
• This independent analysis includes 53 trials with a total of 24,089 patients and is published in the Lancet.
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.
0 20 40 60 8050 7010 30
Relief of Migraine PainRelief of Migraine Pain
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).
Headacherelief at 2 hours*(95% CI)
Zolmitriptan 2.5 mg
Almotriptan 12.5 mg
Sumatriptan 50 mg
Eletriptan 40 mg
Naratriptan 2.5 mg
Rizatriptan 10 mg
Sumatriptan 100 mg
% Patients (N=24,089)
Rizatriptan 10 mg
Freedom from Migraine PainFreedom from Migraine Pain
Pain freeat 2 hours*
(95% CI)
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).
Sumatriptan 100 mg
Zolmitriptan 2.5 mg
Sumatriptan 50 mg
Eletriptan 40 mg
Naratriptan 2.5 mg
Almotriptan 12.5 mg
0 10 20 30 40
% Patients (N=24,089)
50
Almotriptan 12.5 mg
Eletriptan 40 mg
0 10 20 30 40
Sustained Freedom from Migraine PainSustained Freedom from Migraine Pain
Sustained pain free* (95% CI)
% Patients (N=24,089)
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).
Rizatriptan 10 mg
Sumatriptan 100 mg
Zolmitriptan 2.5 mg
Sumatriptan 50 mg
Naratriptan 2.5 mg
Consistency of Migraine TreatmentConsistency of Migraine Treatment
0 10 20 30 40 50 60 70 80 90 100
Headacherelief at
2 hours in at least2 out of
3 attacks*(95% CI)
% Patients (N=24,089)
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).
Rizatriptan 10 mg
Sumatriptan 100 mg
Sumatriptan 50 mg
Eletriptan 40 mg
Naratriptan 2.5 mg
Almotriptan 12.5 mg
0 10 20 30 40 50 60
% Patients (N=24,089)
Consistency of Migraine TreatmentConsistency of Migraine Treatment
Pain free at
2 hoursin at least2 out of 3 attacks*(95% CI)
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).
Rizatriptan 10 mg
Sumatriptan 100 mg
Sumatriptan 50 mg
Eletriptan 40 mg
Naratriptan2.5 mg
Almotriptan 12.5 mg
Tolerability and Safety ProfileTolerability and Safety Profile
• All oral triptans in the meta-analysis were well tolerated.
• “No triptan was demonstrably safer than the others.”
• Safety can only be reliably assessed after large-scale and long-term clinical exposure.
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.
Summary of Efficacy ResultsSummary of Efficacy Results
0 20 40 60 80 100
Headache reliefat 2 hours*
Consistency:pain free
(2 out of 3 attacks)*
Pain freeat 2 hours*
Sustainedpain free*
% Patients (N=24,089)
Consistency: headache relief
(2 out of 3 attacks)*
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).
Rizatriptan 10 mg
Sumatriptan 50 mg
Zolmitriptan 2.5 mg
Eletriptan 40 mg
Almotriptan 12.5 mg
Naratriptan 2.5 mg
Sumatriptan 100 mg
Triptan Meta-Analysis:Triptan Meta-Analysis:Implications for Migraine TreatmentImplications for Migraine Treatment
• Largest independent analysis of migraine therapies provided evidence-based foundation for choosing a first-line triptan.
• At marketed doses, all oral triptans were effective and well tolerated.
• Rizatriptan 10 mg demonstrated high efficacy across key endpoints.*
• Rizatriptan 10 mg offered a high likelihood of success “when consistent and rapid freedom from pain is desired.”
Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.*Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).