Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment

A meta-analysis of 53 trials

Michel D. Ferrari, Krista I. Roon, Richard B. Lipton, Peter J. Goadsby

Research output: Contribution to journalArticle

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Abstract

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 Results: 53 clinical trials (12 unpublished) involving 24 089 patients, met the criteria for inclusion.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.

Original languageEnglish (US)
Pages (from-to)1668-1675
Number of pages8
JournalLancet
Volume358
Issue number9294
DOIs
StatePublished - Nov 17 2001

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Tryptamines
Serotonin 5-HT1 Receptor Agonists
Migraine Disorders
Meta-Analysis
Serotonin
zolmitriptan
Therapeutics
Headache
Sumatriptan
Pain
Pharmaceutical Preparations
Thorax
Central Nervous System
Randomized Controlled Trials
Placebos
Research Personnel
Clinical Trials
Guidelines
Recurrence
eletriptan

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment : A meta-analysis of 53 trials. / Ferrari, Michel D.; Roon, Krista I.; Lipton, Richard B.; Goadsby, Peter J.

In: Lancet, Vol. 358, No. 9294, 17.11.2001, p. 1668-1675.

Research output: Contribution to journalArticle

Ferrari, Michel D. ; Roon, Krista I. ; Lipton, Richard B. ; Goadsby, Peter J. / Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment : A meta-analysis of 53 trials. In: Lancet. 2001 ; Vol. 358, No. 9294. pp. 1668-1675.
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