Subcutaneous sumatriptan in the acute treatment of migraine

Ensink, F. B. M.

doi:10.1007/bf01642910

Cited by 45 publications

(40 citation statements)

References 7 publications

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“…Thirteen trials were not included in the analysis: six allowed rescue medication within 2 h [12][13][14][15][16][17]. one was published twice [18], one was an interim analysis of a trial that was later published in full [19], one was a subgroup analysis of patients in two trials which had been published previously [20], one contained inconsistencies about the number of patients with adequate pain relief [21], one assessed pain relief but not at 2 h [22], and two did not provide data on the first administration in a cross-over design [23,24].…”

Section: Search For Studies and Inclusion Criteriamentioning

confidence: 99%

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Craen¹,

Tijssen²,

Gans

et al. 2000

Journal of Neurology

241

157

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We carried out a meta-analysis of 22 trials to determine the comparative placebo effect of (a) subcutaneous vs. oral and (b) in-hospital vs. at-home administration in the treatment of migraine. The headache relief rates were combined from the placebo arms of these randomised clinical trials assessing the value of sumatriptan in acute treatment of migraine. The main outcome measure was the proportion of patients reclassified from severe or moderate headache severity to no or mild headache severity 2 h after the beginning of treatment. In the oral regimen 222 of 865 patients (25.7%) reported no or mild headache severity after 2 h, compared to 279 of 862 patients (32.4%) of those receiving subcutaneous placebo (6.7% difference; 95% CI 2.4-11.0%). Adjusting for treatment setting and severity of headache at baseline did not change the observed difference. After placebo treatment at home 285 of 1,054 patients (27.0%) reported no or mild headache severity after 2 h, compared to 216 of 673 patients (32.1%) among those receiving placebo in hospital (5.1 % difference; 95% CI 0.6-9.5%). When adjusted for route of administration and severity of headache at baseline, the difference in relief rates between home and hospital setting disappeared. These findings indicate that subcutaneous administration enhances the placebo effect of acute treatment of migraine. Future trials of antimigraine drugs assessing the relative efficacy of various routes of administration should use a double-dummy technique. The interpreting of placebo-controlled trial results must therefore consider that the effect in the drug arm of the trial depends in part on the route of administration.

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Section: Search For Studies and Inclusion Criteriamentioning

confidence: 99%

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Craen¹,

Tijssen²,

Gans

et al. 2000

Journal of Neurology

241

157

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“…Sterile neurogenic inflammation in dural blood vessels may contribute to migraine headache (Moskowitz et al, 1989). The selective 5-HT1 receptor agonist, sumatriptan, is a novel, highly effective treatment for migraine headache (Cady et al, 1991;Ensink, 1991;Ferrari, 1991). Its efficacy has been attributed to its ability to constrict selectively dilated, oedematous intracranial blood vessels via activation of 5-HT, receptors on the vascular smooth muscle (Humphrey et al, 1990;Humphrey & Feniuk, 1991).…”

Section: Introductionmentioning

confidence: 99%

Lack of effect of sumatriptan and UK‐14,304 on capsaicin‐induced relaxation of guinea‐pig isolated basilar artery

O’Shaughnessy¹,

Waldron²,

Connor³

1993

British J Pharmacology

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1 The objectives of this study were to assess the effects of sensory neuropeptide antagonists and presynaptically acting receptor agonists on capsaicin-induced relaxations of guinea-pig isolated basilar artery (GPBA). 2 Capsaicin, human a-calcitonin gene-related peptide (CGRP) and substance P (SP) caused concentration-related relaxations of GPBA which had been pre-contracted with prostaglandin F2. (PGF2.).Responses to capsaicin were not modified by the peptidase inhibitors, phosphoramidon (1 JAM) and bestatin (100 gM). 3 The relaxant responses to capsaicin were blocked in a selective manner by ruthenium red (3 gM) and by the CGRP antagonist, CGRP8-37 (1 JAM). CGRP8_37 also selectively inhibited the relaxant effects of CGRP.4 The selective NK1 receptor antagonist, GR82334 (10 JAM), inhibited SP-induced relaxations but had little effect on capsaicin-induced relaxations. 5 The 5-HT1 receptor agonist, sumatriptan, produced small contractions of GPBA under conditions of resting tone. In the presence of PGF2a, sumatriptan had no further contractile effect. Sumatriptan (0.3 and 3JM) did not modify capsaicin-induced relaxations of GPBA.6 The M2-adrenoceptor agonist, UK-14,304 (0.1 JM), had no effect on basal or PGFu-induced tone.UK-14,304 did not modify capsaicin-induced relaxations. 7 These results suggest that capsaicin causes relaxation of GPBA via a release of CGRP. This process is amenable to blockade by CGRP8-37 and ruthenium red, but not to modulation by either sumatriptan or UK-14,304.

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“…This understanding has led to the evaluation of sumatriptan in the acute treatment of migraine (Cady et aI., 1991;Ensink, 1991;Ferrari et aI., 1991;Patten, 1991). It has been proposed that during a migraine headache, intracranial blood vessels in the dura and large arteries supplying the brain are dis tended, inflamed, and pain sensitive (Moskowitz et aI., 1989).…”

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confidence: 99%

Effect of Sumatriptan, a Selective 5-HT₁-like Receptor Agonist, on Pial Vessel Diameter in Anaesthetised Cats

Connor

Stubbs

Feniuk

et al. 1992

J Cereb Blood Flow Metab

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Summary: The action of sumatriptan, a selective 5-HT) like receptor agonist that is effective for the acute treat ment of migraine, was compared on pial vessel diameter following perivascular or intravenous administration to anaesthetised cats. Sumatriptan (0.01-10 /J-M), when mi croinjected perivascularly, caused a decrease in pial ar tery diameter (maximum change of -19 ± 9%; mean ± SD) but had no effect on the diameter of pial veins. Suma triptan (l /J-M)-induced pial artery vasoconstriction was unaffected by coadministration of ketanserin (l /J-M) or ondansetron (l /J-M) but was significantly (p < 0.01) at tenuated by methiothepin (l/J-M). Intravenous infusion of a clinically effective dose of sumatriptan (64 /J-g/kg/l0 min) caused selective carotid vasoconstriction (22 ± 6% Sumatriptan (GR43175) is a novel, highly selec tive agonist for the 5-HT1-like receptor, which me diates vasoconstriction of certain blood vessels (Humphrey et aI., 1988). This 5-HT1 receptor sub type was first identified in dog isolated saphenous vein but appears to be largely restricted to intracra nial blood vessels (Humphrey et aI., 1988(Humphrey et aI., , 1990b. Thus, it has been shown that sumatriptan causes contraction of isolated large cerebral arteries from dog, primate, and humans (Connor et aI., 1989; Par sons et aI., 1989) and human isolated dural arteries (Humphrey et aI., 1990b) via activation of 5-HTJlike receptors but has little or no effect on tone in most peripheral isolated vascular preparations (Humphrey et aI., 1988). Similarly, in vivo, suma triptan selectively constricts the carotid vascular bed in anaesthetised dogs (Feniuk et aI., 1989) and cats (Perren et aI., 1989). This selective action of sumatriptan for the cranial vasculature reflects the Received April 15, 1991; final revision received October 10, 1991; accepted December 9, 1991.Address correspondence and reprint requests to Dr. H. E. Connor at Department of Neuropharmacology, Glaxo Group Re search Ltd., Park Road, Ware, Hertfordshire, SGl2 ODP, U. K. 514increase in carotid vascular resistance with little or no change in blood pressure or heart rate) and no change in pial artery diameter, although sumatriptan (l /J-M) admin istered perivascularly in these animals before and after the infusion caused pial artery vasoconstriction. These results demonstrate that perivascularly administered sumatriptan causes pial artery vasoconstriction via acti vation of 5-HTclike receptors. However, intravenously administered sumatriptan does not cause pial artery va soconstriction, which suggests that sumatriptan does not readily penetrate the cerebrovascular intima.

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Subcutaneous sumatriptan in the acute treatment of migraine

Cited by 45 publications

References 7 publications

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Lack of effect of sumatriptan and UK‐14,304 on capsaicin‐induced relaxation of guinea‐pig isolated basilar artery

Effect of Sumatriptan, a Selective 5-HT₁-like Receptor Agonist, on Pial Vessel Diameter in Anaesthetised Cats

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Subcutaneous sumatriptan in the acute treatment of migraine

Cited by 45 publications

References 7 publications

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Lack of effect of sumatriptan and UK‐14,304 on capsaicin‐induced relaxation of guinea‐pig isolated basilar artery

Effect of Sumatriptan, a Selective 5-HT1-like Receptor Agonist, on Pial Vessel Diameter in Anaesthetised Cats

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Effect of Sumatriptan, a Selective 5-HT₁-like Receptor Agonist, on Pial Vessel Diameter in Anaesthetised Cats