Eletriptan Treatment of Migraine in Patients Switching from Barbiturate-Containing Analgesics: Results from a Multiple-Attack Study

Abstract

The aim of this study was to examine efficacy and tolerability of eletriptan in patients switched from barbiturate-containing combinations (Fiorinal), Fioricet. Migraineurs (n = 160) meeting IHS criteria, with unsatisfactory response in the past year to butalbital-containing combinations, treated up to 16 attacks over 3 months with eletriptan 40 mg. Assessments included headache response and pain-free rates and functional impairment at baseline and 2 h postdose, and global ratings of treatment satisfaction at 24 h. At 2 h postdose, average headache response and pain-free rates were 71% (95% CI, 69-74%) and 37% (95% CI, 35-40%), respectively; 68.5% of patients (95% CI, 65-72%) reported functional response. Within-patient analysis found no efficacy diminution over time (no tolerance). Average headache recurrence rate was 20% (95% CI, 18-23%). Eletriptan was well-tolerated; 6 (3.7%) patients discontinued due to adverse events. There were no serious treatment-related adverse events. We conclude that in poor responders to butalbital-caffeine combinations, switching to eletriptan 40 mg was well-tolerated and efficacious.

Eletriptan in Migraine Patients Reporting Unsatisfactory Response to Rizatriptan

“…Previously, eletriptan was also shown to be effective in treating patients who reported a poor response to NSAIDs, aspirin/acetaminophen/caffeine combination analgesics, and barbiturate‐containing analgesics 7–9 . In all 3 switch studies, 2‐hour headache response rates to eletriptan 40 mg ranged from 66% to 81%, while the 2‐hour pain‐free rate ranged from 25% to 48%.…”

“…Previously, eletriptan was also shown to be effective in treating patients who reported a poor response to NSAIDs, aspirin/acetaminophen/caffeine combination analgesics, and barbiturate-containing analgesics. [7][8][9] In all 3 switch studies, 2-hour headache response rates to eletriptan 40 mg ranged from 66% to 81%, while the 2-hour pain-free rate ranged from 25% to 48%. As expected, the range of headache and painfree response rates when switching from nontriptan analgesics to eletriptan is notably higher than when switching from rizatriptan or sumatriptan to eletriptan.…”

“…The step-care strategy is based on the higher response rate achieved when a patient is switched from an over-the-counter analgesic (eg, a nonsteroidal antiinflammatory drug [NSAID]) to triptan therapy. 7,8 A smaller body of research has reported benefits associated with switching from a narcotic analgesic to eletriptan, 9 and from an ergotamine compound to a triptan. 10 The benefit of the final treatment option, withinclass switching to an alternative triptan, has been studied in 4 previously reported clinical trials, all involving unsatisfactory response to sumatriptan.…”

Eletriptan: a review and new perspectives

“…A total of 68.5% of patients reported functional response with an average 2-h headache response rate of 71% and an average pain-free rate of 37%, and it proved well tolerated [43].…”

“…Eletriptan has shown high response rates in patients who were poor responders to NSAIDs [42], sumatriptan [34] and NSAID-butalbital-caffeine combination products [43].…”