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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.

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Presentation on theme: "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."— Presentation transcript:

1 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)

2 0204060 80 50701030 90100 What Patients Want From Migraine Drug Therapy Adapted from Lipton RB et al. Headache 1999;39(suppl 2):S20-S26. *Most commonly selected as important or very important. % Migraineurs reporting each attribute (n=688) No recurrence* Rapid onset* No side effects Relief of associated symptoms Route of administration Complete pain relief*87% 86% 83% 79% 76% 56%

3 Triptan Meta-Analysis: Background Objective To evaluate the available clinical trial evidence base for oral triptan (5HT 1B/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 02040608050701030 Relief of Migraine Pain 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). Headache relief at 2 hours* (95% CI) Zolmitriptan 2.5 mg Almotriptan 12.5 mg Sumatriptan 50 mg Eletriptan 40 mg Naratriptan 2.5 mg Rizatriptan 10 mg Sumatriptan 100 mg % Patients (N=24,089)

5 Rizatriptan 10 mg Freedom from Migraine Pain Pain free at 2 hours* (95% CI) 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). Sumatriptan 100 mg Zolmitriptan 2.5 mg Sumatriptan 50 mg Eletriptan 40 mg Naratriptan 2.5 mg Almotriptan 12.5 mg 010203040 % Patients (N=24,089) 50

6 Almotriptan 12.5 mg Eletriptan 40 mg 010203040 Sustained Freedom from Migraine Pain Sustained pain free* (95% CI) % 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). Rizatriptan 10 mg Sumatriptan 100 mg Zolmitriptan 2.5 mg Sumatriptan 50 mg Naratriptan 2.5 mg

7 Consistency of Migraine Treatment 0 102030405060708090100 Headache relief at 2 hours in at least 2 out of 3 attacks* (95% CI) % 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). Rizatriptan 10 mg Sumatriptan 100 mg Sumatriptan 50 mg Eletriptan 40 mg Naratriptan 2.5 mg Almotriptan 12.5 mg

8 0 102030405060 % Patients (N=24,089) Consistency of Migraine Treatment Pain free at 2 hours in at least 2 out of 3 attacks* (95% CI) 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). Rizatriptan 10 mg Sumatriptan 100 mg Sumatriptan 50 mg Eletriptan 40 mg Naratriptan 2.5 mg Almotriptan 12.5 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 020406080100 Headache relief at 2 hours* Consistency: pain free (2 out of 3 attacks)* Pain free at 2 hours* Sustained pain free* % Patients (N=24,089) Consistency: headache relief (2 out of 3 attacks)* 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). Rizatriptan 10 mg Sumatriptan 50 mg Zolmitriptan 2.5 mg Eletriptan 40 mg Almotriptan 12.5 mg Naratriptan 2.5 mg 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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