Differences reported among migraine treatments

NEW YORK, Nov 20 (Reuters Health) - Sumatriptan is the first and most widely prescribed member of a class of drugs called triptans, which are used to treat migraine. Seven different triptans will soon be available. While all have been proven effective, subtle differences may mean their ultimate success depends on the patient, new study findings suggest.

"Patients' characteristics and preferences vary, and individual responses to a triptan cannot be predicted," according to lead author Dr. Michel D. Ferrari of Leiden University Medical Centre in the Netherlands and colleagues.

"When one triptan fails, another drug within the class may well succeed in meeting the patient's needs," Ferrari said in a statement.

To investigate, the researchers analyzed 53 clinical trials of the various triptans involving more than 24,000 patients.

Overall, 79% to 89% of migraine patients responded to treatment with triptans, compared with only half of those given an inactive placebo pill. And 51% to 59% of patients reported that they were pain-free 2 hours after triptan treatment, the authors report in the November 17th issue of The Lancet.

Individuals who took 10 milligrams (mg) rizatriptan or 80 mg eletriptan showed greater responses 2 hours after taking the drugs than those who received 100 mg of sumatriptan - the standard treatment. Eletriptan was less tolerable for patients than sumatriptan, but rizatriptan was more consistent, the findings show.
Patients who received 10 mg rizatriptan, 80 mg eletriptan or 12.5 mg almotriptan were relieved of pain more rapidly than those who received the standard treatment. Almotriptan was more tolerable and consistent than the conventional treatment but was similarly effective; rizatriptan was similarly tolerable but more effective and consistent; and eletriptan was less effective but more tolerable.

Treatment with 40 mg and 80 mg of eletriptan allowed for fewer migraine recurrences than standard treatment, while more migraine recurrences were noted for individuals treated with 5 mg and 10 mg of rizatriptan, the report indicates.

Side effects associated with the various triptans included mild tingling; warm sensations in the head, neck, chest and limbs; confusion; dizziness; chest pain and shortness of breath. No triptan proved to be safer than any other.

Ferrari and his colleagues have received previous support and funding from Glaxo Wellcome, AstraZeneca, Pfizer, and a number of other pharmaceutical companies.

SOURCE: The Lancet 2001;358:1668-1675.