title: Zolmitriptan nasal spray exhibits good long-term safety and tolerability in migraine: results of the INDEX trial.
abstract: BACKGROUND
  Previous studies have shown that zolmitriptan 5 mg nasal spray has a fast onset of action, high efficacy, and good tolerability in the acute treatment of migraine. Objective.-This open-label, noncomparative, multicenter, multinational phase III study was designed to further evaluate the long-term safety and tolerability of zolmitriptan 5 mg nasal spray in a population of migraineurs largely naive to triptan nasal sprays who treated multiple migraine attacks over a 1-year period.
  
  
  METHODS
  Patients were required to have an established diagnosis of migraine with or without aura (based on International Headache Society criteria), a high frequency of migraine attacks, and were allowed to treat migraine with any baseline headache intensity. A secondary objective of the study was to assess the long-term efficacy of zolmitriptan nasal spray. A subgroup analysis aimed to determine whether rhinitis had any influence on outcomes of treatment.
  
  
  RESULTS
  The safety population consisted of 538 patients who treated 20,717 migraine attacks with zolmitriptan 5 mg nasal spray. Overall, adverse events occurred in 32.8% of attacks, and led to treatment withdrawal in 4.5% of patients. The most common adverse events were unusual taste (19.0%) and paresthesia (6.8%). Adverse events were generally of mild intensity, transient, and well tolerated, showing a decline in incidence over time. Serious adverse events were rare. The presence of rhinitis and use of a second dose of trial medication had no effect on the incidence of adverse events. At 2 hours, 53.8% of attacks treated with zolmitriptan nasal spray 5 mg were rendered pain free. The highest 2-hour pain free rates were seen for headaches of mild baseline intensity (83.3%), followed by headaches of moderate (56.5%), and severe (32.2%) baseline intensity. The 2-hour pain-free rate remained consistent throughout the study period. The presence of rhinitis had no effect on efficacy.
  
  
  CONCLUSIONS
  Zolmitriptan 5 mg nasal spray demonstrated a well-tolerated and efficacious profile in the acute treatment of multiple migraine attacks over a 1-year period.
authors.affiliation: King's Headache Services, King's College Hospital, London, UK
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Dowson
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Charlesworth
authors.forename: Judy
authors.initials: J
authors.lastname: Green
authors.forename: Markus
authors.initials: M
authors.lastname: Färkkilä
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Steen Boes
authors.initials: SB
authors.lastname: Hansen
authors.forename: Marek
authors.initials: M
authors.lastname: Gawel
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D023303:Oxazolidinones / Q000008:administration & dosage* / Q000009:adverse effects; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014363:Tryptamines
chemical_list: D023303:Oxazolidinones; D017366:Serotonin Receptor Agonists; D014363:Tryptamines; C089750:zolmitriptan