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Progress in Clinical Neurosciences A Systematic Review of the Use of Triptans in Acute Migraine

Published online by Cambridge University Press:  02 March 2017

Marek J. Gawel ,
Irene Worthington  and
Anne Maggisano
Marek J. Gawel*
Affiliation:
Division of Neurology, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, Canada
Irene Worthington
Affiliation:
Metro Toronto Hospitals Drug Information Service (MetroDIS), Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, Canada
Anne Maggisano
Affiliation:
Metro Toronto Hospitals Drug Information Service (MetroDIS), Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, Canada
*
Division of Neurology, Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5
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Abstract:

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Objective:

A systematic review of the literature was undertaken, to consolidate evidence concerning the efficacy and safety of triptans currently available in Canada (sumatriptan, rizatriptan, naratriptan, zolmitriptan), and to provide guidelines for selection of a triptan.

Methods:

Data from published, randomized, placebo-controlled trials were pooled and a combined number needed to treat (NNT) and number needed to harm (NNH) was generated for each triptan. Direct comparative trials of triptans were also examined.

Results:

The lowest NNTfor headache response/pain-free at one/two hours is observed with subcutaneous sumatriptan. Among the oral formulations, the lowest NNT is observed with rizatriptan and the highest NENT with naratriptan. The lowest NNH is observed with subcutaneous sumatriptan.

Conclusions:

Triptans are relatively safe and effective medications for acute migraine attacks. However, differences among them are relatively small. Considerations in selecting a triptan include individual patient response/tolerance, characteristics of the attacks, relief of associated symptoms, consistency of response, headache recurrence, delivery systems and patient preference.

Résumé:

RÉSUMÉ:Objectif:

Nous avons procédé à une revue systématique de la littérature pour consolider les données pertinentes à l'efficacité et à la sécurité des triptans disponibles au Canada (sumatriptan, rizatriptan, naratriptan, zolmitriptan), et pour élaborer des lignes directrices quant à la sélection d'un triptan.

Méthodes:

Les données des études randomisées ayant un groupe placebo, qui ont été publiées, ont été regroupées et un NNT et NNH combiné a été déterminé pour chaque triptan (NNT: number needed to treat - nombre d'individus à traiter pour prévenir un incident; NNH: number needed to harm – nombre d'individus à traiter pour qu'en moyenne un effet indésirable survienne). Les essais comparatifs de triptans ont également été examinés.

Résultats:

Le NNTle plus bas, pour la réponse définie comme l'absence de céphalée après une à deux heures, est observé avec l'administration sous-cutanée de sumatriptan. En ce qui concerne les préparations orales, le NNT le plus bas a été observé avec le rizatriptan et le plus élevé avec le naratriptan. Le NNH le plus bas a été observé avec le sumatriptan sous-cutané.

Conclusions:

Les triptans sont des médicaments relativement sûrs et efficaces pour traiter les accès aigus de migraine. Cependant, les différences entre eux sont relativement faibles. Les aspects à considérer dans le choix d'un triptan sont: la réponse et la tolérance du patient, les caractéristiques des accès, le soulagement des symptômes associés, la constance de la réponse, la récurrence de la céphalée, le mode d'administration et la préférence du patient.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 1 , February 2001 , pp. 30 - 41
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

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