Early responses in randomized clinical trials of triptans in acute migraine treatment. Are they clinically relevant? A comment.
One can question the clinical relevance of early headache responses after oral and intranasal triptans. Thus, for pain-free the early responses were significant but in absolute values they were only a few percentages: the therapeutic gains (TGs) were 1.8% (95% CI = 0.3-3%) for oral almotriptan 12.5 after 30 minutes and 1.0% (95% CI = 0-2%) after intranasal zolmitriptan 5 mg after 15 minutes. These results are compared with subcutaneous sumatriptan 6 mg which has TGs of 11% (95% CI = 7-15%) to 14% (95% CI = 11-17%) for pain-free after 30 minutes. Subcutaneous sumatriptan has a 2 times higher response rate than intranasal zolmitriptan and is 5 times more effective than oral almotriptan at these early time points. It is concluded that if a very early and clinically relevant effect is desired then the migraine patient should use the subcutaneous administration form of sumatriptan.
Tfelt-Hansen
Peer
P
Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, DK-2600 Glostrup, Denmark.
D000281:Administration, Intranasal; D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D006801:Humans; D007279:Injections, Subcutaneous / Q000592:standards; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014363:Tryptamines / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use
D014363:Tryptamines