Efficacy of triptans for the treatment of acute migraines: a quantitative comparison based on the dose-effect and time-course characteristics

• Published in: European journal of clinical pharmacology Vol. 75; no. 10; pp. 1369 - 1378
• Main Authors: Hou, Mengyuan, Liu, Hongxia, Li, Yunfei, Xu, Ling, He, Yingchun, Lv, Yinghua, Zheng, Qingshan, Li, Lujin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2019; Springer Nature B.V
• Subjects: Acute Disease; Administration, Oral; Biomedical and Life Sciences; Biomedicine; Dosage; Dose-Response Relationship, Drug; FDA approval; Headache; Humans; Migraine; Migraine Disorders - drug therapy; Models, Biological; Oral administration; Pain; Pain - drug therapy; Patients; Pharmacodynamics; Pharmacology/Toxicology; Placebos; Randomized Controlled Trials as Topic; Serotonin Receptor Agonists - administration & dosage; Sumatriptan; Tryptamines - administration & dosage; Vasoconstrictor Agents - administration & dosage; Triptans; Pain-free; Pain-relief; Dose-effect; Time-course; Migraine
• ISSN: 0031-6970; 1432-1041; 1432-1041
• DOI: 10.1007/s00228-019-02748-4

Objectives This study aimed to establish a pharmacodynamic model to quantitatively compare the efficacy characteristics of seven kinds of triptans and their different dosage forms in the treatment of acute migraines. Methods Clinical studies of triptans in the treatment of acute migraines were comprehensively searched in the public databases. Pharmacodynamic models were established to describe the dose-effect and time-course of each kind of triptan for the proportion of patients who became pain free or had pain relief. Results A total of 92 articles involving 47,376 subjects were included in the analysis. After eliminating the placebo effect, oral eletriptan (40 mg) had the highest efficacy among all oral drugs at the maximum approved dose, and the proportion of patients who became pain free and had pain relief were 30.9% and 37.9% at 2 h, respectively. However, oral naratriptan (2.5 mg) had the lowest efficacy, and the proportion of patients who became pain free and had pain relief was 10.3% and 21.6% at 2 h, respectively. The efficacy of subcutaneous administration was significantly higher than that of oral administration, and the efficacy of nasal spray administration was comparable to that of oral administration. Regarding the dose-effect, the efficacy of the sumatriptan nasal spray significantly increased within the FDA (Food and Drug Administration)-approved dose range. When the dose was increased from 5 to 20 mg of sumatriptan nasal spray, the proportion of patients who became pain free and had pain relief increased by 16.8% and 18.3% at 2 h, respectively. Regarding the time-course, the time of onset of subcutaneous sumatriptan (6 mg) was the fastest, and the fraction of patients who were pain free at 2 h accounted for 90.6% of that at 4 h. Conclusions This study evaluated the efficacy characteristics of seven kinds of triptans and their different dosage forms. The present findings provide necessary quantitative information for migraine medication guidelines.