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Although triptans are widely used in the acute management of migraine, there is uncertainty around the comparative efficacy of triptans among each other and vs non-triptan migraine treatments.
“Triptans” are
5HT-1B/1D receptor agonists that were developed to treat acute migraine.
Migraine treatment based on the duration, severity of pain, associated
symptoms, degree of disability and initial response to the therapy. Several
databases were reviewed upon to show the productiveness of triptans in
comparison to other treatments.
Although triptans
are widely used in the acute management of migraine, there is uncertainty
around the comparative efficacy of triptans among each other and vs non-triptan
migraine treatments. We conducted systematic reviews and network meta-analyses
to compare the relative efficacy of triptans (alone or in combination with
other drugs) for acute treatment of migraines compared with other triptan
agents, non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid
(ASA), acetaminophen, ergots, opioids, or anti-emetics.
The Cochrane
Library, MEDLINE, and EMBASE were searched for randomized controlled trials
that compared triptans (alone or in combination with other drugs) with
placebo-controlled or active migraine treatments. Study selection, data
extraction, and quality assessment were completed independently by multiple
reviewers. Outcome data were combined and analyzed using a Bayesian network
meta-analysis. For each outcome, odds ratios, relative risks, and absolute
probability of response were calculated.
A total of 133
randomized controlled trials met the inclusion criteria. Standard dose triptans
relieved headaches within 2 hours in 42 to 76% of patients, and 2-hour
sustained freedom from pain was achieved for 18 to 50% of patients. Standard
dose triptans provided sustained headache relief at 24 hours in 29 to 50% of
patients, and sustained freedom from pain in 18 to 33% of patients. Use of
rescue medications ranged from 20 to 34%. For 2-hour headache relief, standard
dose triptan achieved better outcomes (42 to 76% response) than ergots (38%);
equal or better outcomes than NSAIDs, ASA, and acetaminophen (46 to 52%); and
equal or slightly worse outcomes than combination therapy (62 to 80%). Among
individual triptans, sumatriptan subcutaneous injection, rizatriptan ODT,
zolmitriptan ODT, and eletriptan tablets were associated with the most
favorable outcomes.
Triptans are
effective for migraine relief. Standard dose triptans are associated with
better outcomes than ergots, and most triptans are associated with equal or better
outcomes compared with NSAIDs, ASA, and acetaminophen. Use of triptans in
combination with ASA or acetaminophen, or using alternative modes of
administration such as injectables, may be associated with slightly better
outcomes than standard dose triptan tablets.
Headache. 2015 Jul-Aug
Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis
Cameron C et al.
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