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New triptan shows promise for patients unresponsive
to sumatriptan in migraine
Eletriptan (Relpax), a new oral treatment for migraine,
is safe and effective in patients who are poor responders to sumatriptan
(Imigran), say researchers.
The results of a placebo-controlled study were reported
last week at the World Congress of Neurology in London by Professor Jes
Olesen of the department of neurology at Glostrup Hospital in Denmark.
The study enrolled 466 patients who were randomised
to receive eletriptan 40mg, eletriptan 80mg or placebo for the treatment
of up to three migraine attacks, after failing to receive adequate relief
from sumatriptan. Of these patients, 404 took at least one dose and 246
had three attacks that were treated. Patients recorded migraine symptoms
and response to treatment.
Professor Olesen reported that, at two hours, headache
response rates were 59 per cent for eletriptan 40mg (P 0.0001 versus
placebo), 70 per cent for eletriptan 80mg (P 0.0001 versus placebo,
P 0.05 versus eletriptan 40mg) and 30 per cent for placebo. Pain-free
response rates at two hours were 35 per cent and 42 per cent for eletriptan
40mg and 80mg, respectively, compared with 7 per cent for placebo (P
0.0001 for both doses of eletriptan).
“Eletriptan could be effective for a wider range
of patients than sumatriptan,“ said Professor Olesen. He added that when
the study was designed, the expectation was that eletriptan would be more
effective than sumatriptan in patients unresponsive to sumatriptan, but
that it would only be slightly better than placebo. This was because patients
who had not responded to one triptan might not respond to another. “However,
the results of this study show that, in these patients, eletriptan is
significantly more effective than placebo.”
Professor Olesen reported that response to the new
triptan was consistent, with 66 per cent of patients given the 40mg dose
achieving a two-hour headache response for at least two out of three attacks.
This proportion increased to 72 per cent in the patients given 80mg eletriptan.
The proportion for patients given placebo was 15 per cent. Patients given
eletriptan also reported less migraine-associated nausea than those given
placebo at both one and two hours.
Professor Olesen said that the most common side
effects reported during the study were asthenia, somnolence, nausea and
dizziness. These were typical of side effects reported for other triptans,
he added.
At the end of the study, patients were asked to
rate whether or not they would use the treatment that they had been given
again. Of those given eletriptan, 62 per cent said they would use it again
in preference to previous treatment.
A spokeswoman for Pfizer, the company developing
eletriptan, told The Journal on June 26 that the drug had now received
marketing authorisation in the United Kingdom. However, eletriptan was
not likely to be available to patients for at least a couple of months.
Relpax is a prescription-only medicine licensed
for the acute treatment of migraine with or without aura.
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