Migraine Treatment With Rizatriptan and Almotriptan: A Crossover Study
Daisy S. Ng-Mak, PhD; X. H. Hu, MD, PhD; Marcelo Bigal, MD, PhD
Abstract
Background: Rizatriptan and almotriptan are effective and well-tolerated triptans that have not been compared directly.
Objective: To evaluate the effectiveness of rizatriptan 10 mg and almotriptan for the acute treatment of migraine, in a real -world setting.
Methods: Of a large, multicenter, open-label , crossover study, we conducted a substudy to contrast the effectiveness of rizatriptan 10 mg and almotriptan 12.5 mg for the acute treatment of 2 migraine attacks in a sequential, crossover manner. Time to outcome was assessed using stopwatches. Mean and median times to onset of pain relief (PR) and pain freedom (PF) for rizatriptan and almotriptan were compared. The effect of rizatriptan on times to onset of PR and PF, adjusting for potential confounding factors (treatment sequence, treatment order, and use of rescue medication), was computed via a Cox proportional hazard model.
Background: Rizatriptan and almotriptan are effective and well-tolerated triptans that have not been compared directly.
Objective: To evaluate the effectiveness of rizatriptan 10 mg and almotriptan for the acute treatment of migraine, in a real -world setting.
Methods: Of a large, multicenter, open-label , crossover study, we conducted a substudy to contrast the effectiveness of rizatriptan 10 mg and almotriptan 12.5 mg for the acute treatment of 2 migraine attacks in a sequential, crossover manner. Time to outcome was assessed using stopwatches. Mean and median times to onset of pain relief (PR) and pain freedom (PF) for rizatriptan and almotriptan were compared. The effect of rizatriptan on times to onset of PR and PF, adjusting for potential confounding factors (treatment sequence, treatment order, and use of rescue medication), was computed via a Cox proportional hazard model.
Results: Out of the 146 patients taking almotriptan as their usual care medication, 79 used stopwatch for both attacks. Significantly more patients taking rizatriptan achieved onset of PR within 2 hours after dosing than those taking almotriptan (88.6% vs 73.4%, P = .007). A higher proportion of patients taking rizatriptan achieved PF within 2 hours after dosing than those taking almotriptan (55.7% vs 45.6%, P = .10). Times to onset of PR and PF were significantly shorter with those patients taking rizatriptan than with those taking almotriptan (median time to PR: 45 vs 60 minutes, P = .002; median time to PF: 100 vs 135 minutes, P = .004). The adjusted proportional hazard ratios (rizatriptan vs almotriptan) for times to onset of PR and PF were 1.51 (95% confidence interval 1.20 to 1.88) and 1.42 (95% confidence interval 1.15 to 1.76), respectively. More patients were very satisfied when treating their attacks with rizatriptan than with almotriptan. Rizatriptan was preferred by most patients.
Conclusions: Times to achieve PR and PF were significantly shorter for patients using rizatriptan , as compared with those using almotriptan.
Introduction
A wide range of medications are available for the acute treatment of migraine, including both nonmigraine-specific and migraine -specific medications .[1] Among available acute migraine medications , triptans are considered to be the class of choice for patients with attack-related disability.[2,3] The efficacy and safety of triptans have been demonstrated by numerous randomized, placebo-controlled trials ,[4- 7] but few studies have contrasted triptans in head-to-head clinical trials , and most of these studies used sumatriptan as the comparator (eg,[8-10 ]).
Comparative efficacy evidence among oral triptans is scant.[11- 13] The most cited source for comparisons is a large meta-analysis that includes 53 clinical controlled triptan trials . Among its conclusions, it was found that almotriptan 12.5 mg, eletriptan 80 mg, and rizatriptan 10 mg were among the most effective triptans, as measured by 2-hour pain relief (PR).[14 ] Echoing the meta-analysis, Goadsby et al reported that almotriptan 12.5 mg , eletriptan 80 mg , and rizatriptan 10 mg were the top choices for migraine treatment. [15 ] It was suggested that rizatriptan is associated with a better clinical efficacy, while almotriptan is associated with better tolerability.
Despite the differing attributes presented by the various triptans, the relative importance of these attributes from the perspective of the migraine sufferer is not well known. Large randomized clinical trials (RCTs), while helpful , may not capture the clinical nuances that determine patient preferences for medications. For example, it is unknown whether patients' preference for triptans follows a consistent or random pattern. Similarly, it is unknown whether patients' preferences are
reflected in the outcomes measured by clinical trials.[16] Although rizatriptan and almotriptan have never been compared in RCTs, other types of contrasts have been performed . For example, a pharmacy prescription study[17 ] found that more patients treated with rizatriptan 10 mg, compared with almotriptan 12.5 mg , used only 1 tablet for acute migraine treatment (78% vs 58%) and, on average, consumed fewer tablets per attack (1.19 vs 1 .43). In contrast, using the patient's preference as the primary outcome variable, a recent randomized, open-label, crossover clinical trial reported that 9% more patients preferred almotriptan 12.5 mg over rizatriptan 10 mg; [18 ] however , the difference was not found to be statistically significant.
As direct , head-to-head comparisons between rizatriptan and almotriptan have not been performed, and results from observational studies differed, herein we conducted analysis from a large study where patients used rizatriptan 10 mg or almotriptan 12.5 mg in a real-life situation (treating as usual), to measure patients' preference as a function of treatment attributes .
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Conclusions: Times to achieve PR and PF were significantly shorter for patients using rizatriptan , as compared with those using almotriptan.
Introduction
A wide range of medications are available for the acute treatment of migraine, including both nonmigraine-specific and migraine -specific medications .[1] Among available acute migraine medications , triptans are considered to be the class of choice for patients with attack-related disability.[2,3] The efficacy and safety of triptans have been demonstrated by numerous randomized, placebo-controlled trials ,[4- 7] but few studies have contrasted triptans in head-to-head clinical trials , and most of these studies used sumatriptan as the comparator (eg,[8-10 ]).
Comparative efficacy evidence among oral triptans is scant.[11- 13] The most cited source for comparisons is a large meta-analysis that includes 53 clinical controlled triptan trials . Among its conclusions, it was found that almotriptan 12.5 mg, eletriptan 80 mg, and rizatriptan 10 mg were among the most effective triptans, as measured by 2-hour pain relief (PR).[14 ] Echoing the meta-analysis, Goadsby et al reported that almotriptan 12.5 mg , eletriptan 80 mg , and rizatriptan 10 mg were the top choices for migraine treatment. [15 ] It was suggested that rizatriptan is associated with a better clinical efficacy, while almotriptan is associated with better tolerability.
Despite the differing attributes presented by the various triptans, the relative importance of these attributes from the perspective of the migraine sufferer is not well known. Large randomized clinical trials (RCTs), while helpful , may not capture the clinical nuances that determine patient preferences for medications. For example, it is unknown whether patients' preference for triptans follows a consistent or random pattern. Similarly, it is unknown whether patients' preferences are
reflected in the outcomes measured by clinical trials.[16] Although rizatriptan and almotriptan have never been compared in RCTs, other types of contrasts have been performed . For example, a pharmacy prescription study[17 ] found that more patients treated with rizatriptan 10 mg, compared with almotriptan 12.5 mg , used only 1 tablet for acute migraine treatment (78% vs 58%) and, on average, consumed fewer tablets per attack (1.19 vs 1 .43). In contrast, using the patient's preference as the primary outcome variable, a recent randomized, open-label, crossover clinical trial reported that 9% more patients preferred almotriptan 12.5 mg over rizatriptan 10 mg; [18 ] however , the difference was not found to be statistically significant.
As direct , head-to-head comparisons between rizatriptan and almotriptan have not been performed, and results from observational studies differed, herein we conducted analysis from a large study where patients used rizatriptan 10 mg or almotriptan 12.5 mg in a real-life situation (treating as usual), to measure patients' preference as a function of treatment attributes .
DOWNLOAD COMPLETE PDF HERE
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