Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta‐Analysis

Abstract

Background.-Although triptans are widely used in the acute management of migraine, there is uncertainty around the comparative efficacy of triptans among each other and vs non-triptan migraine treatments. We conducted systematic reviews and network meta-analyses to compare the relative efficacy of triptans (alone or in combination with other drugs) for acute treatment of migraines compared with other triptan agents, non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), acetaminophen, ergots, opioids, or anti-emetics.Methods.-The Cochrane Library, MEDLINE, and EMBASE were searched for randomized controlled trials that compared triptans (alone or in combination with other drugs) with placebo-controlled or active migraine treatments. Study selection, data extraction, and quality assessment were completed independently by multiple reviewers. Outcome data were combined and analyzed using a Bayesian network meta-analysis. For each outcome, odds ratios, relative risks, and absolute probability of response were calculated.Results.-A total of 133 randomized controlled trials met the inclusion criteria. Standard dose triptans relieved headaches within 2 hours in 42 to 76% of patients, and 2-hour sustained freedom from pain was achieved for 18 to 50% of patients. Standard dose triptans provided sustained headache relief at 24 hours in 29 to 50% of patients, and sustained freedom from pain in 18 to 33% of patients. Use of rescue medications ranged from 20 to 34%. For 2-hour headache relief, standard dose triptan achieved better outcomes (42 to 76% response) than ergots (38%); equal or better outcomes than NSAIDs, ASA, and acetaminophen (46 to 52%); and equal or slightly worse outcomes than combination therapy (62 to 80%). Among individual triptans, sumatriptan subcutaneous injection, rizatriptan ODT, zolmitriptan ODT, and eletriptan tablets were associated with the most favorable outcomes.

The Comparıson Of Trıptans, Nsaıd Or Combınatıon On Mıgraıne Attack Treatment

“…Triptan ve NSAİİ kombinasyon tedavisinin sınandığı bir çok çalışma bu sonucu desteklemektedir. [11][12][13] Migren serebral korteks, beyin sapı, PAG, aminerjik nukleuslar, yüksek servikal duyu nöronları ve trigeminovasküler sistemin çok yönlü etkileşimleriyle oluşur. [14] Periferik duyarlılaşma sonucu trigeminovasküler sistem aktivasyonu ve meninkslerde nöroje-nik enflamasyon oluşur.…”

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

“…Considering the outcome headache-free response at 2 hours, triptan standard doses gave better results than ergot's (42-76% and 38% response, respectively) and equal or better responses than NSAIDs, aspirin and acetaminophen [Cameron et al 2015;Diener et al 2002]. Moreover, eletriptan tablets, together with sumatriptan subcutaneous injection and rizatriptan and zolmitriptan, showed the most favorable responses among all triptans [Cameron et al 2015]. Compared with zolmitriptan, eletriptan 80 mg, but not 40 mg, showed significant superiority when considering the 2-hour headache-response outcome.…”

“…A recent systematic review and network metaanalysis of 133 randomized controlled trials that compared triptans with placebo-controlled or active migraine treatments showed that triptan standard doses provided a headache-free response in 42-76% of patients and a sustained headachefree response in 29-50% of patients with a rescuemedication-use rate of about 27% [Cameron et al 2015]. Considering the outcome headache-free response at 2 hours, triptan standard doses gave better results than ergot's (42-76% and 38% response, respectively) and equal or better responses than NSAIDs, aspirin and acetaminophen [Cameron et al 2015;Diener et al 2002].…”

Overview of Triptans in the Treatment of Acute Migraine

“…Cameron and colleagues conducted a systemic review and network meta-analysis comparing the relative efficacy of triptans using the Cochrane Library, Medline and Embase (133 randomised trials). 14 The main efficacy variables (headache relief within 2 hours, 2-hour sustained freedom from pain, sustained headache relief and freedom from pain at 24 hours) were met by standard doses of triptans with rates from 18-76% of patients.…”

“…Generally, triptans provided equal or better outcomes than other migraine treatments but slightly worse efficacy than combination therapy. 14 This review examines the use of the currently licensed triptans for the treatment of acute migraine and practical considerations when selecting a triptan for this indication. The efficacy and safety of the triptans using data from clinical trials and real-world studies will be compared.…”