Evaluating the efficacy of migraine therapy.
In patient surveys and analyses of clinical trial data, patients with migraine cite rapid and complete relief of headache pain as the single most important attribute of a migraine medication. Other desirable attributes cited by patients include lack of migraine recurrence; absence of adverse effects; and relief of associated symptoms, such as nausea, vomiting, and increased sensitivity to light and noise. Data from most clinical trials of migraine drugs use standard endpoints of level of pain relief at 2 hours and percentage of patients who are pain free at 2 hours. Using these endpoints, however, a drug that relieves pain within 30 minutes after administration would be considered equivalent to a drug that does not relieve pain until 1.5 hours after administration. Because patients clearly want relief in less than 2 hours, a time to event analysis, which, in comparison trials, credits a drug for more rapid onset of effect, might be a more useful means of comparing the efficacy of 2 migraine medications. In studies using time to event analyses, the migraine medication rizatriptan has proved superior to sumatriptan in time to pain relief; time to pain-free state; and time to elimination of nausea, photophobia, and phonophobia. Based on these results, rizatriptan may better meet patients' needs than sumatriptan.
Chawluk
J B
JB
Medical College of Pennsylvania, Philadelphia, USA. jcello@uplink.net
D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*; D018170:Sumatriptan / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D014363:Tryptamines / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; D014662:Vasoconstrictor Agents; C093622:rizatriptan; D018170:Sumatriptan