Eletriptan for the Treatment of Migraine in Patients with Previous Poor Response or Tolerance to Oral Sumatriptan

Färkkilä, Markus; Olesen, Jes; Dahlöf, Carl; Stovner, LJ; Bruggen, JP Ter; Rasmussen, S; Muirhead, Nancy; Sikes, Carolyn

doi:10.1046/j.1468-2982.2003.00554.x

Cited by 70 publications

(92 citation statements)

References 19 publications

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“…Eletriptan has demonstrated within-patient consistency of response based on three previous studies using a randomized, double-blind, placebo-controlled, parallelgroup design (10)(11)(12). For eletriptan 40 mg (ELE-40), consistency of response on two out of three attacks ranged from 63% to 77%, and for eletriptan 80 mg (ELE-80), two out of three consistency ranged from 72% to 82%.…”

Section: Introductionmentioning

confidence: 99%

Consistency of eletriptan in treating migraine: Results of a randomized, within-patient multiple-dose study

Almas

Tepper

Landy³

et al. 2013

Cephalalgia

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Objective: The current study evaluated the consistency of eletriptan response. Methods: Using a within-patient crossover design, patients with migraine completed a three-attack, open-label, lead-in period, before being treated, double-blind for four attacks, with either eletriptan 40 mg (ELE-40; N ¼ 539) or eletriptan 80 mg (ELE-80; N ¼ 432); placebo was randomly substituted for the treatment of one attack. Results: On an a priori analysis of within-patient consistency, double-blind treatment was associated with similar 2 hour headache response rates using a !2/3 response criterion for ELE-40 (77%) and ELE-80 (73%), and using a 3/3 response criterion for ELE-40 (46%) and ELE-80 (47%). Within-patient consistency in achieving pain-free status at 2 hours using a !2/3 criterion was slightly higher on ELE-40 (42%) compared with ELE-80 (38%), and was similar using the 3/3 criterion (18% on ELE-40, 17% on ELE-80). On a repeated measures logistic regression analysis across all treated attacks, the probability of achieving a headache response at 2 hours ranged from 71% to 74% on ELE-40 vs. 17% to 28% on placebo (p < 0.0001), and from 66% to 74% on ELE-80 vs. 21% to 27% on placebo (p < 0.0001). The incidence, per attack, of adverse events was low for both ELE-40 and ELE-80. Few adverse events occurred with incidence !10% on ELE-40 (asthenia, 5.0%) or ELE-80 (asthenia, 10%; nausea, 5.8%). Discontinuations because of adverse events were 0.2% on ELE-40, and 1.6% on ELE-80 Conclusion: In this multiple attack study, eletriptan was well-tolerated and demonstrated consistent and significant efficacy in the treatment of migraine.Clinicaltrials.Gov Identifier: NCT01859481

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Section: Introductionmentioning

confidence: 99%

Consistency of eletriptan in treating migraine: Results of a randomized, within-patient multiple-dose study

Almas

Tepper

Landy³

et al. 2013

Cephalalgia

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“…The response rates achieved here with almotriptan cannot be compared directly with those achieved in the trials discussed above [10,12,13] . Although all of the trials recruited patients with a history of poor response to sumatriptan, their study designs were different.…”

Section: Discussionmentioning

confidence: 85%

“…Three other studies have investigated the effi cacy of switching triptan therapy in patients who were poor responders to sumatriptan [10,12,13] .…”

Section: Discussionmentioning

confidence: 99%

“…A more recent double-blind, parallel-group study evaluated eletriptan 40 and 80 mg (80-mg arm is not discussed in this article as it is not an approved single dosage in Germany, the United States, and many other countries) versus placebo across three migraine attacks in patients who had ceased treatment with sumatriptan due to unsatisfactory effi cacy or tolerability [13] . It is of interest that only 49% of study participants had described insuffi cient clinical response as the reason they had stopped taking sumatriptan; 30% had discontinued sumatriptan because of adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Almotriptan in Migraine Patients Who Respond Poorly to Oral Sumatriptan: A Double-Blind, Randomized Trial

et al. 2005

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Objective: To investigate the efficacy and tolerability of almotriptan 12.5 mg in migraine patients who respond poorly to sumatriptan 50 mg. Background: Poor response to sumatriptan therapy for acute migraine attacks has been documented in the literature, but few controlled trials have investigated the efficacy of an alternative triptan in this subgroup of patients. Methods: Patients with an International Headache Society diagnosis of migraine who self-described as experiencing at least two unsatisfactory responses to sumatriptan treated their first migraine attack with open-label sumatriptan 50 mg. Patients who did not achieve 2-hour pain relief (improvement of headache from moderate/severe to mild/no headache) were then randomized to treat their second attack with almotriptan 12.5 mg or placebo under double-blind conditions. Results: In the first attack, 221 of 302 participants (73%) did not achieve 2-hour pain relief with sumatriptan and were randomized to treatment of their second attack with almotriptan 12.5 mg or placebo. Of the 198 sumatriptan nonresponders who treated their second attack (99 almotriptan; 99 placebo), 70% had severe headache pain at baseline. Two-hour pain-relief rates were significantly higher with almotriptan compared to placebo (47.5 vs. 23.2%; p < 0.001). A significant treatment effect for almotriptan was also seen in pain-free rates at 2 h (33.3 vs. 14.1%; p < 0.005) and sustained freedom from pain (20.9 vs. 9.0%; p < 0.05). In the second attack, 7.1% of patients in the almotriptan group experienced adverse events compared to 5.1% in the placebo group (p = 0.77). Conclusions: Almotriptan 12.5 mg is an effective and well-tolerated alternative for patients who respond poorly to sumatriptan 50 mg. A poor response to one triptan does not predict a poor response to other agents in that class.

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“…Both sumatriptan and eletriptan were well tolerated, with low incidence of adverse effects [Goadsby et al 2000;Mathew et al 2003b;Sandrini et al 2002]. Moreover, eletriptan (compared with placebo) has been demonstrated as effective in treating acute migraine in previous nonresponders, or patients not tolerant to sumatriptan [Färkkilä et al 2003]. Other triptan-switch studies reported eletriptan 40 mg efficacy in migraineurs who did not also respond to treatment with rizatriptan and NSAIDs [Bhambri et al 2015].…”

Section: Eletriptan: Efficacy In Head-to-head Studiesmentioning

confidence: 99%

Eletriptan in the management of acute migraine: an update on the evidence for efficacy, safety, and consistent response

Capi

Curto

Lionetto

et al. 2016

Ther Adv Neurol Disord

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Migraine is a multifactorial, neurological and disabling disorder, also characterized by several autonomic symptoms. Triptans, selective serotonin 5-HT 1B/1D agonists, are the first-line treatment option for moderate-to-severe headache attacks. In this paper, we review the recent data on eletriptan clinical efficacy, safety, and tolerability, and potential clinically relevant interactions with other drugs. Among triptans, eletriptan shows a consistent and significant clinical efficacy and a good tolerability profile in the treatment of migraine, especially for patients with cardiovascular risk factors without coronary artery disease. It shows the most favorable clinical response, together with sumatriptan injections, zolmitriptan and rizatriptan. Additionally, eletriptan shows the most complex pharmacokinetic/dynamic profile compared with the other triptans. It is metabolized primarily by the CYP3A4 hepatic enzyme and therefore the concomitant administration of CYP3A4-potent inhibitors should be carefully evaluated. A relatively low risk of serotonin syndrome is given by the coadministration with serotoninergic drugs. No clinically relevant interaction has been found with drugs used for migraine prophylactic treatment or other acute drugs, with the exception of ergot derivatives that should not be co-administered with eletriptan.

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Eletriptan for the Treatment of Migraine in Patients with Previous Poor Response or Tolerance to Oral Sumatriptan

Cited by 70 publications

References 19 publications

Consistency of eletriptan in treating migraine: Results of a randomized, within-patient multiple-dose study

Consistency of eletriptan in treating migraine: Results of a randomized, within-patient multiple-dose study

Almotriptan in Migraine Patients Who Respond Poorly to Oral Sumatriptan: A Double-Blind, Randomized Trial

Eletriptan in the management of acute migraine: an update on the evidence for efficacy, safety, and consistent response

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