Identification of negative predictors of pain-free response to triptans: analysis of the eletriptan database.
Thirty to forty percent of migraineurs do not respond to any given triptan treatment. We identified clinical variables that significantly predict therapeutic non-response and evaluated the efficacy of eletriptan (20, 40 and 80 mg) and sumatriptan (100 mg) vs. placebo in a subgroup of patients with all predictor variables. First-attack data were pooled from 10 randomized, double-blind, placebo-controlled migraine trials (n = 8473). Multivariate regression analyses identified three significant baseline predictors of failure to achieve 2-h pain-free response: severe headache pain, presence of photophobia/phonophobia and presence of nausea. Time of dosing following headache onset did not influence 2-h pain-free response. Among patients with all three risk factors (n = 2010; 24% of total sample), 2-h pain-free response was significantly higher in patients receiving all three doses of eletriptan or sumatriptan vs. placebo (all P < 0.01). Thus, eletriptan and sumatriptan are efficacious in difficult-to-treat patients at high risk for non-response to triptans.
Diener
H-C
HC
Department of Neurology, University of Duisburg-Essen, Essen, Germany. h.diener@uni-essen.de
Dodick
D W
DW
Goadsby
P J
PJ
Lipton
R B
RB
Almas
M
M
Parsons
B
B
D000328:Adult; D016208:Databases, Factual; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D012001:Hyperacusis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015337:Multicenter Studies as Topic / Q000379:methods; D009325:Nausea / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D020795:Photophobia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D011237:Predictive Value of Tests; D011759:Pyrrolidines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013997:Time Factors; D014363:Tryptamines / Q000627:therapeutic use*
D011759:Pyrrolidines; D014363:Tryptamines; C115647:eletriptan