Comparative efficacy of triptans for the abortive treatment of migraine: A multiple treatment comparison meta-analysis

Abstract

Background: Migraine is the most common neurological condition in developed countries. The abortive treatment of migraine attacks is important both for quality of life and costs associated with illness. Triptans, serotonin 5-HT 1B/1D receptor agonists, effectively relieve the pain, disability, and associated symptoms of migraine while improving healthrelated quality of life. Although a number of direct head-to-head triptan comparisons have been made, data for all possible permutations are not available, and unlikely to ever be so, although in clinical practice such information would be useful. Objective: We aimed to determine the relative efficacy of all available triptans to abort migraine headache among patients with previous adequate response to migraine treatments. Methods: We included only double-blinded randomized clinical trials comparing triptans to either placebo or another triptan. Our primary outcomes were pain-free response at two hours and 24-hour sustained pain-free response, and our secondary outcomes were headache response at two hours and 24-hour sustained headache response. We used Bayesian multiple treatment comparison meta-analyses of seven triptans used in adult patients to abort migraine attacks. We applied a random-effects analysis with meta-regression adjusting for dose. Results are reported as odds ratios with 95% credible intervals. Results: We included data from 74 randomized clinical trials. All triptans were significantly superior to placebo for all outcomes, with the exception of naratriptan for 24-hour sustained pain-free response. Eletriptan consistently yielded the highest treatment effect estimates. For the two-hour endpoints, eletriptan was statistically significantly superior to sumatriptan, almotriptan, naratriptan, and frovatriptan for at least one of the two outcomes. Rizatriptan yielded the second highest treatment effects followed by zolmitriptan. For the 24-hour endpoints, eletriptan was statistically significantly superior to sumatriptan, rizatriptan, almotriptan, and naratriptan for at least one of the two outcomes. Frovatriptan data were not available at that endpoint.Further, the probability that eletriptan is the most likely of all triptans to produce a favorable outcome was 68% for pain-free response at two hours, and 54% for 24-hour sustained pain-free response. Conclusion: Triptans appear to offer differing treatment effects. In the populations studied eletriptan was most likely to produce pain-free responses that were sustained.

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

“…At two hours eletriptan is the most effective triptan, followed by rizatriptan, zolmitriptan, and sumatriptan. [31] …”

A Combination of Tanacetum parthenium, Griffonia simplicifolia and Magnesium (Aurastop) as Symptomatic Acute Treatment for Migraine Aura: A Retrospective Cohort Study

“…Whereas visual disturbances represented the most common clinical presentation, sensory and language symptoms may be reported, in line with the slow spreading of a cortical perturbation across the brain, moving from posterior to anterior regions [6] (cortical spreading depression, CSD), followed by a longlasting depression [7] [8]. The utilization of 5-hydroxytryptamine 1B/D agonists (triptans) significantly relieved migraine pain and disability with a concomitant increased quality of life [9]. Unfortunately, effective treatments for aura signs and symptoms (in particular for those patients with substantial disability due to aura duration and severity) are not yet well established.…”

Outcome for headache and pain-free nonresponders to treatment of the first attack: A pooled post-hoc analysis of four randomized trials of eletriptan 40 mg

“…The efficacy of oral triptans for the acute treatment of migraine has been established based on multiple randomized, double-blind, placebo-controlled trials (2,3). The results of meta-analyses indicate that approximately 35%-40% of patients do not achieve a headache response at two hours on the first triptantreated attack (2,3).…”