Which triptan for migraine relief?

November 15, 2001

N.B. Please note that if you are outside North America the embargo for Lancet Press material is 0001 hours UK time Friday 16th November 2001.

A meta-analysis of a class of drugs called the triptans-known to be effective for migraine relief -is detailed in this week's issue of THE LANCET. Three oral triptans-10 mg rizatriptan, 80 mg eletriptan, and 12.5 mg almotriptan-offer the best future chance of success.

The triptans (also known as selective serotonin 5-HT1B/1D agonists) are very effective and generally well-tolerated acute migraine drugs. Seven different oral triptans will soon be clinically available, making evidence-based selection guidelines necessary.

Michel Ferrari from Leiden University Medical Centre, The Netherlands, and colleagues pooled and analysed raw data from all the 53 available controlled clinical trials with oral triptans (12 unpublished), involving a total of over 24,000 patients. Compared with 100 mg sumatriptan, 10 mg rizatriptan showed better efficacy and consistency, and similar tolerability; 80 mg eletriptan showed better efficacy, similar consistency, but lower tolerability; 12·5 mg almotriptan showed similar efficacy after two hours of use, but scored better on the other results; 2·5 mg naratriptan and 20 mg eletriptan showed lower efficacy and (the first two) better tolerability; 2·5 mg and 5 mg zolmitriptan, 40 mg eletriptan, and 5 mg rizatriptan showed results very similar to those of 100 mg sumatriptan. The results of the 22 trials that directly compared pairs of triptans showed the same overall pattern of results.

Michel Ferrari comments: "There is an enormous body of evidence supporting the effectiveness and tolerability of the triptans in the war against migraine. Depending upon the patients' priorities, the optimal agents can be selected. In addition, when one triptan fails another drug within the class may well succeed in meeting the patients needs. Physicians thus need more than one triptan in their repertoire to best treat patients with migraine."
Contacts: Dr Michel Ferrari, Associate Professor of Neurology, Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; T) +31 71 526 2895; F) +31 71 524 8253; E) M.D.Ferrari@LUMC.NL

Professor Peter Goadsby, Professor of Neurology, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1 ,UK; T) +44 (0)20 7829 8749; E) peterg@ion.ucl.ac.uk

Professor Richard Lipton, Professor of Neurology, Epidemiology and Social Medicine, Albert Einstein College of Medicine, New York, NY; USA; T) +1 203 321 1050; E) rlipton@imrinc.com


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