TY - JOUR
T1 - Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment
T2 - A meta-analysis of 53 trials
AU - Ferrari, Michel D.
AU - Roon, Krista I.
AU - Lipton, Richard B.
AU - Goadsby, Peter J.
N1 - Funding Information:
M D Ferrari's salary is fully covered by LUMC. He has received: consultancy and industry support from Allergan, Almirall, AstraZeneca, Boehringer, Glaxo Wellcome, Merck, Sharpe & Dohme, Pfizer, SmithKlineBeecham, Vanguard Medica; grant support from Glaxo Wellcome, Merck, Sharpe & Dohme; and independent support from NWO, Asclepiade, Migraine Trust, Dutch Brain Trust, Biomed EC, Dutch Heart Foundation, and the Gisela Thier Foundation. P J Goadsby's salary is fully covered by Wellcome Trust. He has received: consultancy and industry support from Allergan, Almirall, AstraZeneca, Boehringer, Glaxo Wellcome, Merck, Sharpe & Dohme, Pfizer, SmithKlineBeecham, Vanguard Medica; grant support from Wellcome Trust, Migraine Trust, Brain Research Trust/ION; a clinical staff salary from SKB, AstraZeneca, Glaxo Wellcome, and Pfizer, AstraZeneca, SKB. R B Lipton has received financial support in the form of research grants as a principal investigator, consulting fees, and lecture honoraria from several triptan manufacturers (Astra-Zeneca, Elan/Vanguard, Glaxo Wellcome, Merck, Sharpe & Dohme, Pfizer). Most of his funds have been paid by his employer.
Funding Information:
P J Goadsby is supported by the Migraine Trust and the Wellcome Trust, and is a Wellcome Senior Research Fellow.
PY - 2001/11/17
Y1 - 2001/11/17
N2 - Background: The triptans, selective serotonin 5-HT1B/1D agonists, are very effective acute migraine drugs with a well-developed scientific rationale. Seven different triptans will soon be clinically available, making evidence-based selection guidelines necessary. Triptan trials have similar designs, facilitating meta-analysis; this will provide a foundation for using triptans in clinical practice. Method: We asked pharmaceutical companies and the principal investigators of company-independent trials for raw patient data of all double-blind, randomised, controlled, clinical trials of oral triptans in migraine. We calculated summary estimates across studies for important efficacy and tolerability parameters, and separately summarised direct comparator trials. Results: 53 clinical trials (12 unpublished) involving 24 089 patients, met the criteria for inclusion. Mean results for 100 mg sumatriptan were 59% (95% CI 57-60) for 2 h headache response (improvement from moderate or severe to mild or no pain); 29% (27-30) for 2 h pain free (improvement to no pain); 20% (18-21) for sustained pain free (pain free by 2 h and no headache recurrence or use of rescue medication 2-24 h post dose); and 67% (63-70) for consistency (response in at least two of three treated attacks); placebo-subtracted proportions for patients with at least one adverse event (AE) were 13% (8-18), for at least one central nervous system AE 6% (3-9), and for at least one chest AE 1.9% (1.0-2.7). Compared with these data, 10 mg rizatriptan showed better efficacy and consistency, and similar tolerability; 80 mg eletriptan showed better efficacy, similar consistency, but lower tolerability; 12.5 mg almotriptan showed similar efficacy at 2 h but better other results; 2.5 mg naratriptan and 20 mg eletriptan showed lower efficacy and (the first two) better tolerability; 2.5 mg and 5 mg zolmitriptan, 40 mg eletriptan, and 5 mg rizatriptan showed very similar results. The results of the 22 trials that directly compared triptans show the same overall pattern. We received no data on frovatriptan, but publicly available data suggest lower efficacy. Interpretation: At marketed doses, all oral triptans were effective and well tolerated. 10 mg rizatriptan, 80 mg eletriptan, and 12.5 mg almotriptan provide the highest likelihood of consistent success.
AB - Background: The triptans, selective serotonin 5-HT1B/1D agonists, are very effective acute migraine drugs with a well-developed scientific rationale. Seven different triptans will soon be clinically available, making evidence-based selection guidelines necessary. Triptan trials have similar designs, facilitating meta-analysis; this will provide a foundation for using triptans in clinical practice. Method: We asked pharmaceutical companies and the principal investigators of company-independent trials for raw patient data of all double-blind, randomised, controlled, clinical trials of oral triptans in migraine. We calculated summary estimates across studies for important efficacy and tolerability parameters, and separately summarised direct comparator trials. Results: 53 clinical trials (12 unpublished) involving 24 089 patients, met the criteria for inclusion. Mean results for 100 mg sumatriptan were 59% (95% CI 57-60) for 2 h headache response (improvement from moderate or severe to mild or no pain); 29% (27-30) for 2 h pain free (improvement to no pain); 20% (18-21) for sustained pain free (pain free by 2 h and no headache recurrence or use of rescue medication 2-24 h post dose); and 67% (63-70) for consistency (response in at least two of three treated attacks); placebo-subtracted proportions for patients with at least one adverse event (AE) were 13% (8-18), for at least one central nervous system AE 6% (3-9), and for at least one chest AE 1.9% (1.0-2.7). Compared with these data, 10 mg rizatriptan showed better efficacy and consistency, and similar tolerability; 80 mg eletriptan showed better efficacy, similar consistency, but lower tolerability; 12.5 mg almotriptan showed similar efficacy at 2 h but better other results; 2.5 mg naratriptan and 20 mg eletriptan showed lower efficacy and (the first two) better tolerability; 2.5 mg and 5 mg zolmitriptan, 40 mg eletriptan, and 5 mg rizatriptan showed very similar results. The results of the 22 trials that directly compared triptans show the same overall pattern. We received no data on frovatriptan, but publicly available data suggest lower efficacy. Interpretation: At marketed doses, all oral triptans were effective and well tolerated. 10 mg rizatriptan, 80 mg eletriptan, and 12.5 mg almotriptan provide the highest likelihood of consistent success.
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U2 - 10.1016/S0140-6736(01)06711-3
DO - 10.1016/S0140-6736(01)06711-3
M3 - Article
C2 - 11728541
AN - SCOPUS:0035904760
VL - 358
SP - 1668
EP - 1675
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9294
ER -