Comparison of Subcutaneous Sumatriptan with Usual Acute Treatments for Migraine

Abstract

246 migraine patients (International Headache Society definition, 1-6 severe attacks per month) were randomised into a multicentre, cross-over study comparing subcutaneous (s.c.) sumatriptan 6 mg administered by an auto-injector (Glaxo device) with usual acute migraine treatments. Patients were treated for 2 months or up to 12 attacks, and then crossed over to the alternative treatment for the same duration. Usual treatments were: analgesics (including combinations), 49%; ergotamine, 24%; NSAIDs 19%; DHE, 7%. Rescue medication was allowed 2 h after the first dose. Headache was assessed on a 4-point self-rating scale (0: none, 1: mild, 2: moderate, 3: severe). Other migraine symptoms were assessed as present or absent. Quality of life was assessed before the study and at the end of each treatment period. Two hundred and seventeen patients were eligible for the cross-over analysis. At 2 h post-dosing, an average of 78% of attacks per patient were successfully relieved (grade 3 or 2 to 1 or 0) by s.c. sumatriptan, compared with 34% for the usual treatments (p < 0.001) and 63% of attacks per patient were completely relieved (grade 0) by s.c. sumatriptan compared with 15% for the usual treatments (p < 0.001). Sumatriptan-treated patients used rescue medication for 19% of their attacks, compared to 59% for comparator drugs (p = 0.001). Results for patient preference were: s.c. sumatriptan, 85%; usual treatments, 10%; no preference, 5% (p < 0.001). Sumatriptan was significantly superior to comparator drugs for all other efficacy end-points (p < 0.001). Improvements in quality of life scores were 3 times higher in sumatriptan-treated patients than in those taking usual treatments (p < 0.0001); the tolerability of both treatments was good. In conclusion, s.c. sumatriptan was superior to the usual acute treatments for both the relief of all migraine symptoms and the improvement in quality of life.

Patients’ preference for triptans and other medications as a tool for assessing the efficacy of acute treatments for migraine

“…All studies of preference [14][15][16][17][18][19]22] and satisfaction [17,[19][20][21] for triptans compared with patients' usual non-triptan medications have demonstrated the superiority of the triptans. Patients' most commonly given reasons for preferring triptans were effective relief, speed of relief, restored ability to function and fewer side effects [16,18,19,22].…”

“…Sumatriptan A prospective, multicentre, open-label, 2-month crossover study compared patients' preference for subcutaneous sumatriptan 6 mg with their usual acute migraine treatments [15]. Single and combination analgesics were used by 49% of patients, ergotamine by 24%, non-steroidal anti-inflammatory drugs (NSAIDs) by 19% and dihydroergotamine (DHE) by 7%.…”

Sumatriptan (50 and 100 mg) in repeated migraine attacks: a patient preference study

“…Patient behaviour is important for drug compliance: sometimes a low response rate to migraine treatments is mainly due to lack of compliance rather than to poor drug effectiveness. The patient preference evaluation has been used in the past to evaluate prophylaxis treatments [7], but now is also widely used for acute attacks [8,9]. This end-point has also been applied in a trial aimed to compare patients' preferences between oral and subcutaneous sumatriptan in migraine [10].…”

A comparison of preference for and efficacy of tablet formulations of sumatriptan (50 mg and 100 mg), naratriptan (2.5 mg), rizatriptan (10 mg), and zolmitriptan (2.5 mg) in the acute treatment of migraine

“…Patients' preference for migraine-specific therapy with the 5HT1B/1D agonist triptans over non-specific therapies such as analgesics and nonsteroidal anti-inflammatory drugs is well established [6][7][8]. Patients' preference for…”

“…Data on patients' preferences for migraine medication can help to tailor therapy to the needs of the individual patient by providing patient-centered information supplemental to that obtained from traditional efficacy measures [3][4][5].That preference data supplement rather than duplicate information from traditional efficacy measures is illustrated by the finding that preference for a migraine medication does not necessarily correspond with traditional endpoints such as headache relief [4,5].Patients' preference for migraine-specific therapy with the 5HT1B/1D agonist triptans over non-specific therapies such as analgesics and nonsteroidal anti-inflammatory drugs is well established [6][7][8]. Patients' preference for…”