Patterns of Use of Triptans and Reasons for Switching Them in a Tertiary Care Migraine Population

Sheftell, Fred D.; Feleppa, Michele; Tepper, Stewart J.; Volcy, Michel; Rapoport, Alan M.; Bigal, Marcelo E.

doi:10.1111/j.1526-4610.2004.04124.x

Cited by 52 publications

(66 citation statements)

References 14 publications

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“…Two studies showed that more patients preferred oral sumatriptan 50 or 100 mg than other oral triptans [11,31,32]. Two studies showed few differences between several oral triptans [33,34], and a further study showed that patients preferred zolmitriptan nasal spray over oral triptans [35]. Different study designs and the patients' initial triptan may have biased the results from these studies.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective review of 386 patients who used subcutaneous sumatriptan and were switched to a different triptan or formulation, 19.5% returned to subcutaneous sumatriptan [34]. For the other triptans/formulations, the percentages for returning were: sumatriptan 25 mg, 7.8%; sumatriptan 50 or 100 mg, 42.3%; sumatriptan nasal spray, 17.7%; zolmitriptan, 17.6%; rizatriptan, 16.5%; naratriptan, 9.4%.…”

Section: Multiple Comparisons Between the Triptansmentioning

confidence: 99%

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

Dowson

Tepper

Dahlöf³

2005

J Headache Pain

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Oral triptans are effective and well tolerated acute treatments for migraine, but clinical differences between them are small and difficult to measure in conventional clinical trials. Patient preference assesses a global measure of efficacy and tolerability, and may be a more sensitive means of distinguishing between these drugs. In a series of studies, patients consistently expressed a clear preference for triptans over their usual non–triptan acute medications, e.g., analgesics and ergotamine. Direct comparator studies of patient preference with oral triptans showed that patients could distinguish between different triptans, and between different formulations of the same triptan. Patients could even distinguish between the three oral doses of sumatriptan. The most frequently provided reasons for preference were speed of response and overall effectiveness. Patient preference is a sensitive clinical trial endpoint and physicians should consider using it when reviewing the efficacy of acute migraine medications.

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Section: Discussionmentioning

confidence: 99%

Section: Multiple Comparisons Between the Triptansmentioning

confidence: 99%

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

Dowson

Tepper

Dahlöf³

2005

J Headache Pain

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“…Sheftell et al [10] reported that patients receiving rizatriptan experience switching to other drugs least frequently. Ninan et al [11] reported that the pain-free rate in migraine patients receiving rizatriptan at an early stage was significantly higher than those for patients receiving other triptans.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of rizatriptan for patients with migraine: efficacy of drug therapy for migraine accompanied by tension headache–like symptoms, focusing on neck stiffness

2005

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According to an epidemiological study in Japan, there are as many as 22 million patients with tension headache and 8.4 million with migraine. Furthermore, patients suffering from both types of headache concurrently are estimated to account for more than 50% of headache patients. We studied the efficacy of drug therapy for migraine accompanied by tension headache-like symptoms, focusing principally on neck stiffness. We evaluated the efficacy of rizatriptan by comparison of findings before and after therapy in 34 migraine patients, consisting of 16 without neck stiffness (migraine without neck factor: WONF) and 18 with it (migraine with neck factor: WNF), who received treatment at our neurology/internal medicine department from 1 March 2004 to 31 May 2005. In the study, all the patients were asked to keep a record of their migraine status. The severity of migraine was classified by physicians according to the International Headache Society diagnostic criteria, based on which drug efficacy was evaluated. We selected rizatriptan for migraine treatment in our study based on Dr. Ferrari's report. In the efficacy study of rizatriptan, in the group of 34 migraine patients, the pain relief rate (79.4%) and pain-free rate (41.2%) at two hours after treatment were as high as those reported in the meta-analysis performed by Ferrari et al., indicating high efficacy of rizatriptan. In the efficacy comparison between the WONF and WNF groups, the painfree rates were 56.3% and 27.8%, and cumulative pain relief rates were 100% and 61.1%, respectively, with better results in the WONF group. A test result was also significantly better (p=0.0076) in the WONF group. Rizatriptan was proved effective in treating migraine patients accompanied by tension headachelike symptoms. Comparison of efficacy rates between patient groups with and without tension headache-like symptoms showed that the pain relief rate in the group without neck stiffness was higher.

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“…The first triptan introduced in the USA was sumatriptan in a 6-mg subcutaneous (SC) injection. There are currently seven triptans available in the USA with several formulations available for delivery including oral tablets, orally disintegrating tablets, nasal sprays and SC injection [3].…”

Section: Introductionmentioning

confidence: 99%

Sumatriptan 6 mg subcutaneous as an effective migraine treatment in patients with cutaneous allodynia who historically fail to respond to oral triptans

et al. 2007

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The objective of the study was to assess the efficacy of 6 mg subcutaneous (SC) sumatriptan to treat migraine and the relationship between response of migraine and cutaneous allodynia in a population of migraine patients who historically failed to respond to oral triptan medications. This was an openlabel study consisting of patients with migraines who historically failed to respond to oral triptan medications. Forty-three patients were asked to treat three migraine attacks with 6 mg SC sumatriptan. The primary efficacy endpoint was the percentage of patients achieving relief of headache at 2 h. Ninetyone percent of the patients responded to a single dose of SC sumatriptan 6 mg. Fifty percent of all patients were pain-free by 2 h and over 30% had a 24-h sustained pain-free response. When administered within 90 min from the onset of migraine (i.e., during the developing phase of cutaneous allodynia), SC 6 mg sumatriptan proved to be effective despite the occurrence of allodynia in a group of patients, who historically had failed to respond to oral triptan medications. These findings suggest that the window of opportunity to treat allodynic patients with injectable triptans may be longer (up to 2 h) than with oral triptans (up to 1 h).

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Patterns of Use of Triptans and Reasons for Switching Them in a Tertiary Care Migraine Population

Abstract: A variety of treatment attributes are important in determining the reasons involved in switching a triptan. To assess this attributes can provide additional information to supplement the traditional tests of efficacy provided by randomized clinical trials.

Cited by 52 publications

References 14 publications

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

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

Clinical efficacy of rizatriptan for patients with migraine: efficacy of drug therapy for migraine accompanied by tension headache–like symptoms, focusing on neck stiffness

Sumatriptan 6 mg subcutaneous as an effective migraine treatment in patients with cutaneous allodynia who historically fail to respond to oral triptans

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