PJ Online | News: Best triptans for migraine identified

The Pharmaceutical Journal Vol 267 No 7175 p733-738
24 November 2001

Best triptans for migraine identified

All oral triptans are effective for treating migraine but the highest likelihood of successful treatment is found with certain doses of rizatriptan (Maxalt), eletriptan (not yet available in the United Kingdom) and almotriptan (Almogran), according to the results of a meta-analysis.

Study recommendations

Compared with 100mg sumatriptan, the meta-analysis found:

12.5mg almotriptan is 24 per cent better for pain-free response, 30 per cent better for sustained pain-free response and 57 per cent better for adverse events. The researchers suggest using it when high tolerability and good efficacy are required.

80mg eletriptan is 10 per cent better for response, 25 per cent better for pain-free response. They suggest using it when high efficacy and low recurrence rates are required.

10mg rizatriptan is 17 per cent better for response, 38 per cent better for pain-free response and 25 per cent better for sustained pain-free response. They suggest using it when consistent and rapid relief from pain is required.

Dr Michel Ferrari, Leiden University Medical Centre, the Netherlands, and colleagues analysed data from 53 clinical trials on seven oral triptans. They found that in terms of headache response after two hours, compared with 100mg sumatriptan (Imigran), efficacy was higher for 10mg rizatriptan and 80mg eletriptan, and lower for 2.5mg naratriptan (Naramig), 20mg eletriptan and 2.5mg frovatriptan (not yet available in UK). A 2.5mg dose of zolmitriptan (Zomig) gave a slightly higher response than 100mg sumatriptan but differences in rates for other doses and drugs, including 50mg sumatriptan, 5mg zolmitriptan and 5mg rizatriptan, were not significantly different from 100mg sumatriptan.

Pain free rates after two hours showed higher values for 80mg eletriptan, 12.5mg almotriptan and 10mg rizatriptan compared with 100mg sumatriptan. Lower values were seen for 25mg sumatriptan, 2.5mg naratriptan and 20mg eletriptan.

Adverse events occurred least frequently with 2.5mg naratriptan and 12.5mg almotriptan (at rates that did not differ from placebo). The authors comment that the main concern with triptans is their potential for coronary vasoconstriction but since there were no clinically important differences in coronary vasoconstriction effects then no triptan is any safer than the others.

The manufacturer of frovatriptan did not supply data about its drug to the researchers. However, abstracts presented at conferences have allowed the researchers to conclude that its response rate is below that of other triptans. In addition, its rate of adverse events does not differ from that of sumatriptan so they conclude that frovatriptan does not appear to offer any advantage over other triptans.

"Finding the best therapy may involve trial and error: if the first triptan fails one may successfully switch to another. Physicians thus need more than one triptan in their repertoire," they say (Lancet 2001;358: 1668).