The use of multiattribute decision models in evaluating triptan treatment options in migraine

Ferrari, Michel D.; Goadsby, Peter J.; Lipton, Richard B.; Dodick, DW; Cutrer, F. Michael; McCrory, Douglas C; Williams, Paul

doi:10.1007/s00415-005-0769-0

Cited by 23 publications

(12 citation statements)

References 14 publications

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“…According to the methods of the study, all triptans were contrasted to sumatriptan 100 mg 68 . The most important conclusion of the meta-analysis is that all the triptans are more effective than placebo in relieving the pain and associated symptoms of migraine.…”

Section: Differentiating the Triptansmentioning

confidence: 99%

“…Route of Administration may play an important role in the onset of action and in the preference patterns of triptans. subcutaneous delivery of sumatriptan offers the most rapid and complete pain relief of the triptans beginning as early as 10 to 15 minutes, yet it also is associated with a higher incidence of adverse events 68 . Nasal deliveries also seem to yield fast relief 70 .…”

Section: Differentiating the Triptansmentioning

confidence: 99%

See 1 more Smart Citation

Migraine in the triptan era: progresses achieved, lessons learned and future developments

Bigal

Krymchantowski²,

2009

Arq. Neuro-Psiquiatr.

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-Triptans, serotonin 5-HT 1B/1D receptor agonists, more than revolutionizing the treatment of migraine, stimulated also ground breaking research that provided insights into the anatomy, physiology, and molecular pharmacology of migraine. This knowledge, in turn, is stimulating research on new mechanisms of action for the treatment of migraine. Accordingly, it is opportune to critically review the main advances in migraine science that happened in the triptan era. Herein we first review and conceptualize some of the progresses achieved in migraine science during the triptan era. We then review the class of the triptans -mechanism of action and clinical evidence. We close by briefly discussing the class of CGRP receptor antagonists, which is currently being developed for the acute treatment of migraine.Key WoRDs: migraine, triptans, CGRP antagonists, emerging drugs.Migrânea na era dos triptanos: progressos alcançados, lições aprendidas e desenvolvimentos futuros resumo -os triptanos, agonistas serotoninérgicos 5-HT 1B/1D , revolucionaram o tratamento da migrânea promovendo pesquisas que evidenciaram aspectos da anatomia, fisiologia e farmacologia molecular deste tipo prevalente de cefaléia primária. esse conhecimento, por sua vez vem estimulando ainda mais a descoberta de novos mecanismos de ação para drogas anti-migranosas. Assim, é oportuno rever de forma crítica, os maiores avanços na ciência das cefaléias ocorridos durante a era dos triptanos. Inicialmente reveremos e conceituaremos alguns dos progressos obtidos nesta fase seguido de uma revisão profunda dos mecanismos de ação e evidências clínicas para o uso desta classe de fármacos. Finalmente, discutiremos a nova classe dos antagonistas dos receptores do peptideo geneticamente relacionado à calcitonina (CGRP) atualmente em desenvolvimento. Migraine is a chronic neurological disorder characterized by episodic attacks of headache and associated symptoms 1 . Attempts to alleviate the suffering caused by migraine span millennia and encompass treatments as primitive as trepanation of the skull, to increasingly specific medications that act on receptor subtypes implicated in the pathophysiology of migraine 2 . Triptans, serotonin 5-HT 1B/1D receptor agonists, more than revolutionizing the treatment of migraine, stimulated also ground breaking research that provided insights into the anatomy, physiology, and molecular pharmacology of migraine 3 . This knowledge, in turn, is stimulating research on new mechanisms of action for the treatment of migraine. Accordingly, it is opportune to critically review the main advances in migraine science that happened in the triptan era. To do so, we divided this views and reviews in two main components. We first review and conceptualize some of the progresses achieved in migraine science during the triptan era. We focus on selective themes, and for each, we briefly discuss the established concept (status quo), as well as the evolving knowledge on the area. We then review the class of the triptans -mechanism of action an...

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Section: Differentiating the Triptansmentioning

confidence: 99%

Section: Differentiating the Triptansmentioning

confidence: 99%

Migraine in the triptan era: progresses achieved, lessons learned and future developments

Bigal

Krymchantowski²,

2009

Arq. Neuro-Psiquiatr.

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“…In this project, the same 3 triptans, almotriptan, eletriptan and rizatriptan, emerged as the preferred subset, irrespective of whether the attribute importance weights were obtained from neurologists [9], primary care physicians [10] or migraineurs [11,12]. Similarly, almotriptan, eletriptan and rizatriptan were more similar (than sumatriptan, naratriptan or zolmitriptan) to a hypothetical "ideal triptan", when compared using >10 000 sets of computer-generated importance weights which reflected the entire range of values for relative attribute importance [13].…”

Section: Discussionmentioning

confidence: 99%

Selecting the preferred triptans

McCrory

Williams

2004

J Headache Pain

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The objective was to identify a subset of preferred triptans from among available agents. A criterion of dominance was applied to statistically significant differences which emerged from a recent meta-analysis of placebo-controlled trials of the oral triptans in the treatment of acute migraine. Three alternatives—almotriptan 12.5 mg, eletriptan 80 mg and rizatriptan 10 mg—emerged as nondominated. These were not only superior on an individual basis, but, taken as a group, provided statistically significant superiority over the reference product (sumatriptan 100 mg) on all 5 treatment attributes studied. However, one of these, eletriptan 80 mg, is not approved for use as first line treatment, so the subset of preferred triptans for the treatment of acute migraine therefore comprises almotriptan 12.5 mg and rizatriptan 10 mg. Thus, almotriptan 12.5 mg and rizatriptan 10 mg are the preferred agents for the treatment of acute migraine.

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“…Multiattribute decision modeling 66,67 (MADM) is one method that has been used to match drug characteristics to weighted patient preferences, and thus systematically arrive at an optimal choice of drug for a given patient. Unfortunately, the MADM methodology has not been applied to drug treatments for GAD.…”

Section: Conclusion and Place In Therapymentioning

confidence: 99%

Pharmacotherapy Update: Pregabalin in the Treatment of Generalized Anxiety Disorder

Montgomery

Kasper

2010

Clinical Medicine Insights: Therapeutics

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Generalized anxiety disorder (GAD) is a common disorder that is chronic, disabling, and often goes undiagnosed. Currently, four distinct classes of medications have demonstrated efficacy in the treatment of GAD: benzodiazepines, serotonin and/or norepinephrine reuptake inhibitors (SSRIs/SNRIs), histamine H 1 receptor blockers (hydroxyzine), and pregabalin. Pregabalin acts via binding to an α2-δ subunit presynaptic membrane protein that inhibits neurotransmitter release in excited neurons. Pregabalin is renally excreted and undergoes minimal (2%) hepatic metabolism, thus limiting the risk of drug-drug interactions. The efficacy of pregabalin for the treatment of GAD has been established based on the results of 8 double-blind, placebo-controlled, short-term led trials, and one 6-month relapse prevention study. The current review summarizes data showing that pregabalin has a significantly different safety profile from the benzodiazepines (eg, less sedation, less cognitive and psychomotor impairment, less risk of dependence and withdrawal), and SSRI/ SNRI anxiolytics (eg, less gastrointestinal side effects and sexual dysfunction). The review also summarizes efficacy data showing that pregabalin is a broad spectrum anxiolytic that with a speed of onset similar to the benzodiazepines.

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The use of multiattribute decision models in evaluating triptan treatment options in migraine

Abstract: Using the TOPSIS model, almotriptan, eletriptan and rizatriptan were more likely to appear in the top three closest to the hypothetical ideal triptan.

Cited by 23 publications

References 14 publications

Migraine in the triptan era: progresses achieved, lessons learned and future developments

Migraine in the triptan era: progresses achieved, lessons learned and future developments

Selecting the preferred triptans

Pharmacotherapy Update: Pregabalin in the Treatment of Generalized Anxiety Disorder

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