Hans-Christoph Diener1. 1. Department Of Neurology, University of Essen, D-45145 Essen, Germany. h.diener@uni-essen.de
Abstract
BACKGROUND: Triptans are not identical and migraine sufferers respond differently to different triptans. Few studies have evaluated the efficacy of switching triptans in migraine patients who have shown poor response to another agent. OBJECTIVE: To investigate the efficacy and tolerability of almotriptan 12.5 mg in patients who did not achieve 2-h pain relief with sumatriptan 50 mg. METHODS: This double-blind, placebo-controlled study recruited patients with IHS-defined migraine and at least 2 previous unsatisfactory responses tosumatriptan. Those who did not achieve pain relief (moderate or severe pain decreasing to mild or no pain) 2 h after taking oral sumatriptan 50 mg on an open-label basis for the treatment of their first migraine attack during this trial (Attack 1) were randomized to receive either oral almotriptan 12.5 mg or placebo for the treatment of their next migraine attack (Attack 2). RESULTS: Of 302 patients receivingsumatriptan 50 mg for the treatment of their first migraine attack, 221 (73%) did not achieve 2-h pain relief and were randomized to almotriptan 12.5 mg or placebo for the treatment of Attack 2. The majority (70%) of randomized patients treating their headache in Attack 2 reported severe pain at baseline characterizing this as a difficult-to-treat population. In the intent-to-treat population (n = 198), significantly more patients in the almotriptan group compared with the placebo group achieved 2-h complete relief (free from pain and migraine-associated symptoms) at 2 h (17.1% vs. 4.4%; p < 0.05) and sustained pain free (20.9% vs. 9.0%; p < 0.05). Adverse events of mild-to-moderate intensity occurred in 7.1% of patients in the almotriptan group compared to 5.1% in the placebo group (not statistically different). CONCLUSION:Almotriptan is more effective than placebo and similarly well-tolerated for the acute treatment of migraine in patients who responded poorly to oral sumatriptan.
RCT Entities:
BACKGROUND:Triptans are not identical and migraine sufferers respond differently to different triptans. Few studies have evaluated the efficacy of switching triptans in migrainepatients who have shown poor response to another agent. OBJECTIVE: To investigate the efficacy and tolerability of almotriptan 12.5 mg in patients who did not achieve 2-h pain relief with sumatriptan 50 mg. METHODS: This double-blind, placebo-controlled study recruited patients with IHS-defined migraine and at least 2 previous unsatisfactory responses to sumatriptan. Those who did not achieve pain relief (moderate or severe pain decreasing to mild or no pain) 2 h after taking oral sumatriptan 50 mg on an open-label basis for the treatment of their first migraine attack during this trial (Attack 1) were randomized to receive either oral almotriptan 12.5 mg or placebo for the treatment of their next migraine attack (Attack 2). RESULTS: Of 302 patients receiving sumatriptan 50 mg for the treatment of their first migraine attack, 221 (73%) did not achieve 2-h pain relief and were randomized to almotriptan 12.5 mg or placebo for the treatment of Attack 2. The majority (70%) of randomized patients treating their headache in Attack 2 reported severe pain at baseline characterizing this as a difficult-to-treat population. In the intent-to-treat population (n = 198), significantly more patients in the almotriptan group compared with the placebo group achieved 2-h complete relief (free from pain and migraine-associated symptoms) at 2 h (17.1% vs. 4.4%; p < 0.05) and sustained pain free (20.9% vs. 9.0%; p < 0.05). Adverse events of mild-to-moderate intensity occurred in 7.1% of patients in the almotriptan group compared to 5.1% in the placebo group (not statistically different). CONCLUSION:Almotriptan is more effective than placebo and similarly well-tolerated for the acute treatment of migraine in patients who responded poorly to oral sumatriptan.
Authors: Paola Sarchielli; Franco Granella; Maria Pia Prudenzano; Luigi Alberto Pini; Vincenzo Guidetti; Giorgio Bono; Lorenzo Pinessi; Massimo Alessandri; Fabio Antonaci; Marcello Fanciullacci; Anna Ferrari; Mario Guazzelli; Giuseppe Nappi; Grazia Sances; Giorgio Sandrini; Lidia Savi; Cristina Tassorelli; Giorgio Zanchin Journal: J Headache Pain Date: 2012-05 Impact factor: 7.277
Authors: Elizabeth Leroux; Andrew Buchanan; Louise Lombard; Li Shen Loo; Daisy Bridge; Ben Rousseau; Natasha Hopwood; Brandy R Matthews; Uwe Reuter Journal: Adv Ther Date: 2020-09-29 Impact factor: 4.070