Triptans for acute migraine: comparative clinical effectiveness and cost-effectiveness

Membe S, McGahan L, Cimon K, Gawel M, Giammarco R, Mierzwinski-Urban M
Record ID 32007000125
Authors' objectives:

The objectives were to examine the clinical and cost effectiveness of serotonin receptor (5HT1) agonists (triptans):almotriptan, eletriptan, naratriptan, sumatriptan succinate/hemisulfate, rizatriptan, and zolmitriptan fortreatment of acute migraine in adults and adolescents.

Authors' recommendations: Implications for Decision Making; Differences across all triptans have not been demonstrated in adults. No trials were identified that directly compared all available triptans with each other. Instead, most of the evidence suggesting comparative differences in effectiveness are from trials comparing one triptan with sumatriptan. There was no evidence to suggest individuals could be identified who would benefit from a particular triptan versus anyother. More comparisons among triptans are required to establish overall differences. The generalizability of clinical evidence to current practice requires consideration. None of the RCTsidentified investigated the effect of triptan use for early treatment or mild migraine, although this is commonly encouraged in current practice. This practice could change the magnitude of observed responses from that seen in clinical trials. Switching to a different triptan, rather than continuing with the same triptan, is encouraged in current practice and may result in different success measures than that observed in clinical trials. Naratriptan may require special consideration in adults. There is fair evidence to suggest that rizatriptan10 mg is superior to naratriptan 2.5 mg in relieving headache pain, photophobia, and phonophobia at two hours, and providing sustained relief at 24 hours. Fair evidence suggests that sumatriptan 100 mg is superior tonaratriptan 2.5 mg for relieving headache pain at four hours. Because these differences were demonstrated by one trial for each comparison, decisions regarding naratriptan should be reconsidered as new information becomes available. Nasal sumatriptan requires consideration in adolescents. The evidence of effectiveness in adolescents was derived from eight RCTS comparing five triptans to identical placebos. Only sumatriptan 20 mg nasal spray significantly increased the likelihood of a two-hour response, with the combined results of two trials suggesting a number needed-to-treat of 10 (95% CI: 6, 36).The combined response of sumatriptan recipients from both trials showed a 38% response rate for achieving freedom from pain at two hours, with a number needed-to treatof 10 (95% CI: 6, 30]. No compelling economic evidence supporting one triptan over any other could be identified. Only two of the 12 identified economic evaluations incorporated utility into their analyses. Neither study compared all available triptans or used credible estimates of effectiveness. Most cost-effectiveness evaluations harboured flaws, such as failure to identify major costs and benefits or resource use. Given their limitations, the applicability of these studies to Canadian decision makers remains questionable
Authors' methods: Systematic review, Cost study
Project Status: Completed
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Migraine Disorders
  • Tryptamines
Organisation Name: Canadian Agency for Drugs and Technologies in Health
Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
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Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)
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