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)

0 20 40 60 8050 7010 30 90 100

What Patients WantWhat Patients WantFrom Migraine Drug TherapyFrom 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%

Triptan Meta-Analysis:Triptan Meta-Analysis:BackgroundBackground

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.

0 20 40 60 8050 7010 30

Relief of Migraine PainRelief 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).

Headacherelief 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)

Rizatriptan 10 mg

Freedom from Migraine PainFreedom from Migraine Pain

Pain freeat 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

0 10 20 30 40

% Patients (N=24,089)

50

Almotriptan 12.5 mg

Eletriptan 40 mg

0 10 20 30 40

Sustained Freedom from Migraine PainSustained 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

Consistency of Migraine TreatmentConsistency of Migraine Treatment

0 10 20 30 40 50 60 70 80 90 100

Headacherelief at

2 hours in at least2 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

0 10 20 30 40 50 60

% Patients (N=24,089)

Consistency of Migraine TreatmentConsistency of Migraine Treatment

Pain free at

2 hoursin at least2 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

Naratriptan2.5 mg

Almotriptan 12.5 mg

Tolerability and Safety ProfileTolerability 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.

Summary of Efficacy ResultsSummary of Efficacy Results

0 20 40 60 80 100

Headache reliefat 2 hours*

Consistency:pain free

(2 out of 3 attacks)*

Pain freeat 2 hours*

Sustainedpain 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

Triptan Meta-Analysis:Triptan Meta-Analysis:Implications for Migraine TreatmentImplications 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).