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Oral triptans (serotonin 5-HT 1B/1D agonists) in acute migraine treatment: A meta-analysis of 53 trials

Oral triptans (serotonin 5-HT 1B/1D agonists) in acute migraine treatment: A meta-analysis of 53 trials. by Michel D. Ferrari, Krista I. Roon, Richard B. Lipton, Peter J. Goadsby ( Lancet 2001;358:1668-1675). What Patients Want From Migraine Drug Therapy. Complete pain relief*. 87%.

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Oral triptans (serotonin 5-HT 1B/1D agonists) in acute migraine treatment: A meta-analysis of 53 trials

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  1. Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: A meta-analysis of 53 trials by Michel D. Ferrari, Krista I. Roon, Richard B. Lipton, Peter J. Goadsby (Lancet 2001;358:1668-1675)

  2. What Patients WantFrom Migraine Drug Therapy Complete pain relief* 87% No recurrence* 86% Rapid onset* 83% No side effects 79% Relief of associated symptoms 76% Route of administration 56% 0 10 20 30 40 50 60 70 80 90 100 % Migraineurs reporting each attribute (n=688) Adapted from Lipton RB et al. Headache 1999;39(suppl 2):S20-S26. *Most commonly selected as important or very important.

  3. Triptan Meta-Analysis:Background Objective • To evaluate the available clinical trial evidence base for oral triptan (5HT1B/1D agonist) drugs and provide a foundation for their use in managing acute migraine. Background • Given that seven different triptans are clinically available, physicians need evidence-based guidelines to select the triptans with the highest likelihood of success. Methods • Clinical trial databases for randomized and active-controlled studies provided by manufacturers of rizatriptan, sumatriptan, zolmitriptan, eletriptan, almotriptan, and naratriptan. • This independent analysis includes 53 trials with a total of 24,089 patients and is published in the Lancet. Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.

  4. Rizatriptan 10 mg Sumatriptan 100 mg Sumatriptan 50 mg Zolmitriptan 2.5 mg Eletriptan 40 mg Almotriptan 12.5 mg Naratriptan 2.5 mg Relief of Migraine Pain Headache relief at 2 hours* (95% CI) 0 10 20 30 40 50 60 70 80 % Patients (N=24,089) Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

  5. Rizatriptan 10 mg Sumatriptan 100 mg Sumatriptan 50 mg Zolmitriptan 2.5 mg Eletriptan 40 mg Almotriptan 12.5 mg Naratriptan 2.5 mg Freedom from Migraine Pain Pain free at 2 hours* (95% CI) 0 10 20 30 40 50 % Patients (N=24,089) Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

  6. Rizatriptan 10 mg Sumatriptan 100 mg Sumatriptan 50 mg Zolmitriptan 2.5 mg Eletriptan 40 mg Almotriptan 12.5 mg Naratriptan 2.5 mg Sustained Freedom from Migraine Pain Sustained pain free* (95% CI) 0 10 20 30 40 % Patients (N=24,089) Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

  7. Sumatriptan 100 mg Rizatriptan 10 mg Sumatriptan 50 mg Almotriptan 12.5 mg Naratriptan 2.5 mg Consistency of Migraine Treatment Headacherelief at 2 hours in at least 2 out of 3 attacks* (95% CI) Eletriptan 40 mg 10 20 30 40 50 60 70 80 90 100 0 % Patients (N=24,089) Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

  8. Sumatriptan 100 mg Rizatriptan 10 mg Sumatriptan 50 mg Almotriptan 12.5 mg Naratriptan 2.5 mg Consistency of Migraine Treatment Pain free at 2 hours in at least 2 out of 3 attacks* (95% CI) Eletriptan 40 mg 10 20 30 40 50 60 0 % Patients (N=24,089) Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

  9. Tolerability and Safety Profile • All oral triptans in the meta-analysis were well tolerated. • “No triptan was demonstrably safer than the others.” • Safety can only be reliably assessed after large-scale and long-term clinical exposure. Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675.

  10. Summary of Efficacy Results Rizatriptan 10 mg Headache relief at 2 hours* Sumatriptan 100 mg Sumatriptan 50 mg Zolmitriptan 2.5 mg Pain free at 2 hours* Eletriptan 40 mg Almotriptan 12.5 mg Naratriptan 2.5 mg Sustained pain free* Consistency: headache relief (2 out of 3 attacks)* Consistency: pain free (2 out of 3 attacks)* 0 20 40 60 80 100 % Patients (N=24,089) Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

  11. Triptan Meta-Analysis:Implications for Migraine Treatment • Largest independent analysis of migraine therapies provided evidence-based foundation for choosing a first-line triptan. • At marketed doses, all oral triptans were effective and well tolerated. • Rizatriptan 10 mg demonstrated high efficacy across key endpoints.* • Rizatriptan 10 mg offered a high likelihood of success “when consistent and rapid freedom from pain is desired.” Adapted from Ferrari MD et al. Lancet 2001;358:1668-1675. *Comparison of recommended initial doses in SPC and standard comparator in the meta-analysis (sumatriptan 100 mg).

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