Migraine treatment with rizatriptan and almotriptan: a crossover study.
BACKGROUND
Rizatriptan and almotriptan are effective and well-tolerated triptans that have not been compared directly.


OBJECTIVE
To evaluate the effectiveness of rizatriptan 10 mg and almotriptan for the acute treatment of migraine, in a real-world setting.


METHODS
Of a large, multicenter, open-label, crossover study, we conducted a substudy to contrast the effectiveness of rizatriptan 10 mg and almotriptan 12.5 mg for the acute treatment of 2 migraine attacks in a sequential, crossover manner. Time to outcome was assessed using stopwatches. Mean and median times to onset of pain relief (PR) and pain freedom (PF) for rizatriptan and almotriptan were compared. The effect of rizatriptan on times to onset of PR and PF, adjusting for potential confounding factors (treatment sequence, treatment order, and use of rescue medication), was computed via a Cox proportional hazard model.


RESULTS
Out of the 146 patients taking almotriptan as their usual care medication, 79 used stopwatch for both attacks. Significantly more patients taking rizatriptan achieved onset of PR within 2 hours after dosing than those taking almotriptan (88.6% vs 73.4%, P = .007). A higher proportion of patients taking rizatriptan achieved PF within 2 hours after dosing than those taking almotriptan (55.7% vs 45.6%, P = .10). Times to onset of PR and PF were significantly shorter with those patients taking rizatriptan than with those taking almotriptan (median time to PR: 45 vs 60 minutes, P = .002; median time to PF: 100 vs 135 minutes, P = .004). The adjusted proportional hazard ratios (rizatriptan vs almotriptan) for times to onset of PR and PF were 1.51 (95% confidence interval 1.20 to 1.88) and 1.42 (95% confidence interval 1.15 to 1.76), respectively. More patients were very satisfied when treating their attacks with rizatriptan than with almotriptan. Rizatriptan was preferred by most patients.


CONCLUSIONS
Times to achieve PR and PF were significantly shorter for patients using rizatriptan, as compared with those using almotriptan.
Ng-Mak
Daisy S
DS
Epidemiology Department, Merck Research Laboratories, 351 North Sumneytown Pike, North Wales, PA, USA.
Hu
X H
XH
Bigal
Marcelo
M
D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D014363:Tryptamines / Q000008:administration & dosage*
D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C409045:almotriptan; C093622:rizatriptan