מתוך medicontext.co.il
By Steven Reinberg
WESTPORT, CT (Reuters Health) – All oral triptans, which are selective serotonin 5-HT agonists, are effective and generally well tolerated in the treatment of migraine. However, the drugs differ somewhat in efficacy and tolerability, according to the results of a meta-analysis published in the November 17th issue of The Lancet.
"There will soon be seven triptans marketed in the US. Our objective was to summarize what we know from randomized placebo-controlled trials," Dr. Richard B. Lipton from Innovative Medical Research, Stamford, Connecticut, told Reuters Health.
Dr. Lipton and colleagues conducted a meta-analysis of 53 clinical trials that included 24,089 patients; 12 of the studies are unpublished. "There is now a large body of rigorous evidence that shows that all of the triptans have a very favorable efficacy profile and a very favorable tolerability profile," Dr. Lipton said.
The researchers used the 100-mg dose of sumatriptan as their benchmark. Mean sumatriptan responses were as follows. A mean of 59% of patients responded within 2 hours; 29% were pain-free at 2 hours; 20% had a sustained pain-free response, with no recurrence in 24 hours; and 67% had a consistent response to the drug in at least two of three attacks. Thirteen percent of sumatriptan users had at least one adverse event.
When these data were compared with other triptans, Dr. Lipton's team found that the 10-mg dose of rizatriptan had better efficacy and consistency and comparable tolerability. Almotriptan at 12.5 mg had better efficacy, consistency and tolerability.
The 80-mg dose of eletriptan had better efficacy, but was less well tolerated. The 2.5-mg and the 5-mg dose of zolmitriptan, the 40-mg dose of eletriptan and the 5-mg dose of rizatriptan had similar results. Naratriptan at 2.5 mg had greater tolerability but less efficacy, the researchers note.
While they did not have extensive data on frovatriptan, publicly available data suggests that its efficacy is lower than sumatriptan, Dr. Lipton's group reports.
"In fairness, these oral triptans are more similar than they are different, but they do differ in their profiles, which provides physicians with an opportunity to match the drug to patient needs," Dr. Lipton said. For example, patients who cannot stand side effects should receive almotriptan or naratriptan, and patients who want consistency should receive rizatriptan or eletriptan, he noted.
"It is important for physicians to learn to use more than one drug and to use the scientific evidence to individualize therapy," Dr. Lipton concluded.
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