title: Negative predictors of clinical response to triptans in patients with migraine.
abstract: Moderate to severe migraine attacks are treated with triptans. However, about 25% of migraineurs fail to respond to triptans. We investigated the involvement of gene polymorphisms, personality traits and characteristics of headache, and made a scoring system for prediction of clinical response to triptans in patients with migraine. Gene polymorphisms including serotonin (5-HT)(1B) receptor G861C and dopamine receptor 2 (DRD2) C939T, personality traits and characteristics of headache were investigated in 46 consistent responders and 14 inconsistent responders to triptans. The multivariate stepwise logistic regression analysis revealed that age, periorbital/deep orbital pain and C/C genotype carrier at DRD2 C939T were significant factors that contributed independently to the negative response to triptans in patients with migraine. Their odds ratios were 6.329 (40-69 vs. 20-39 years, 95% CI 1.441-27.778), 6.772 (no vs. yes, periorbital/deep orbital pain, 95% CI 1.159-39.580) and 14.085 (non-C/C vs. C/C genotype at DRD2 C939T, 95% CI 1.253-166.667), respectively. The predictive index (PI) of clinical response to triptans in patients with migraine was calculated using these three factors. The score in inconsistent responders (1.6 ± 0.6) was significantly higher than that in consistent responders (0.8 ± 0.7, P < 0.001). Sensibility of low-score (RI = 0) group was 100%, and specificity of high-score (PI ≥ 2) group was 87%. The proposed scoring system should in the future be the object of larger studies to confirm its validity.
authors.affiliation: Department of Pathophysiology, Showa University School of Pharmacy, Shinagawa-ku, Tokyo 142-8555, Japan. masakazu@pharm.showa-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Ishii
authors.forename: Y
authors.initials: Y
authors.lastname: Sakairi
authors.forename: H
authors.initials: H
authors.lastname: Hara
authors.forename: A
authors.initials: A
authors.lastname: Imagawa
authors.forename: S
authors.initials: S
authors.lastname: Shimizu
authors.forename: J
authors.initials: J
authors.lastname: Takahashi
authors.forename: A
authors.initials: A
authors.lastname: Nagamine
authors.forename: Y
authors.initials: Y
authors.lastname: Naito
authors.forename: Y
authors.initials: Y
authors.lastname: Masuda
authors.forename: S
authors.initials: S
authors.lastname: Usami
authors.forename: Y
authors.initials: Y
authors.lastname: Kiuchi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology; D018598:Minisatellite Repeats / Q000235:genetics; D010551:Personality / Q000235:genetics; D010555:Personality Inventory; D011110:Polymorphism, Genetic / Q000235:genetics; D011237:Predictive Value of Tests; D017448:Receptors, Dopamine D2 / Q000235:genetics; D011985:Receptors, Serotonin / Q000235:genetics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012702:Serotonin Antagonists / Q000627:therapeutic use; D050486:Serotonin Plasma Membrane Transport Proteins / Q000235:genetics; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014363:Tryptamines / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D017448:Receptors, Dopamine D2; D011985:Receptors, Serotonin; D012702:Serotonin Antagonists; D050486:Serotonin Plasma Membrane Transport Proteins; D014363:Tryptamines