New migraine drugs: A critical appraisal of the reason why the majority of migraine patients do not receive an adequate medication

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

The last three decades have produced several novel and efficient medications to treat migraine attacks and reduce attack frequency. Additionally, promising approaches for the development of acute therapy and migraine prophylaxis continue to be pursued. At the same time as we witness the development of better and more efficient medications with continuously fewer side effects, we also realise that the high cost of such therapies means that only a minority of migraine patients who could benefit from these medications can afford them. Furthermore, information on cost-effectiveness is still lacking. Here, we compare availiable data, highlight open questions and suggest trials to close knowledge gaps. With good reason, our medicine is evidence-based. However, if this evidence is not collected, our decisions will continue to be based on marketing and assumptions. At the moment, we are not doing justice to our patients.

Related collections

Most cited references 46

Record: found
Abstract: found
Article: not found

Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials.

M D Ferrari, K I Roon, R B Lipton … (2001)

The triptans, selective serotonin 5-HT(1B/1D) agonists, are very effective acute migraine drugs with a well- developed scientific rationale. Seven different triptans will soon be clinically available, making evidence-based selection guidelines necessary. Triptan trials have similar designs, facilitating meta-analysis; this will provide a foundation for using triptans in clinical practice. We asked pharmaceutical companies and the principal investigators of company-independent trials for raw patient data of all double-blind, randomised, controlled, clinical trials of oral triptans in migraine. We calculated summary estimates across studies for important efficacy and tolerability parameters, and separately summarised direct comparator trials. 53 clinical trials (12 unpublished) involving 24089 patients, met the criteria for inclusion. Mean results for 100 mg sumatriptan were 59% (95% CI 57-60) for 2 h headache response (improvement from moderate or severe to mild or no pain); 29% (27-30) for 2 h pain free (improvement to no pain); 20% (18-21) for sustained pain free (pain free by 2 h and no headache recurrence or use of rescue medication 2-24 h post dose); and 67% (63-70) for consistency (response in at least two of three treated attacks); placebo-subtracted proportions for patients with at least one adverse event (AE) were 13% (8-18), for at least one central nervous system AE 6% (3-9), and for at least one chest AE 1.9% (1.0-2.7). Compared with these data, 10 mg rizatriptan showed better efficacy and consistency, and similar tolerability; 80 mg eletriptan showed better efficacy, similar consistency, but lower tolerability; 12.5 mg almotriptan showed similar efficacy at 2 h but better other results; 2.5 mg naratriptan and 20 mg eletriptan showed lower efficacy and (the first two) better tolerability; 2.5 mg and 5 mg zolmitriptan, 40 mg eletriptan, and 5 mg rizatriptan showed very similar results. The results of the 22 trials that directly compared triptans show the same overall pattern. We received no data on frovatriptan, but publicly available data suggest lower efficacy. At marketed doses, all oral triptans were effective and well tolerated. 10 mg rizatriptan, 80 mg eletriptan, and 12.5 mg almotriptan provide the highest likelihood of consistent success.

0 comments Cited 160 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Systematic Review of Migraine Prophylaxis Adherence and Persistence

Zsolt Hepp, Lisa Bloudek, Sepideh F. Varon (2014)

BACKGROUND: Migraine is a common neurological disease affecting 12% of Americans and millions worldwide. Medication adherence has been studied extensively in many chronic conditions, with poor adherence adversely affecting treatment outcomes. However, little is known about adherence to oral prophylaxis for migraine. OBJECTIVES: To examine the literature on assessing oral prophylaxis medication adherence and persistence among migraine patients. METHODS: A systematic search of the PubMed (1966 to present) and EMBASE (1974 to present) databases was conducted to locate prospective and retrospective observational studies and randomized controlled trials (RCTs) of propranolol, amitriptyline, and topiramate. RCTs were pooled, weighted by sample size, and stratified by drug and length of study. Average persistence rates and reasons for discontinuation cited in RCTs were examined for each medication. RESULTS: A total of 788 unique articles were identified using the search criteria, 33 of which were included in the final review. Observational studies (n = 14) showed adherence ranges of 41% to 95% at 2 months, 21% to 80% at 6 months, and 35% to 56% at 12 months and persistence ranges of 41% to 88% at 2 months, 19% to 79% at 6 months, and 7% to 55% at 12 months. Pooled persistence from RCTs on propranolol, amitriptyline, and topiramate (n = 19) showed rates of 77%, 55%, and 57%, respectively, at 16-26 weeks. Adverse events were the most common reason for discontinuation cited (24% for topiramate and 17% for amitriptyline). CONCLUSIONS: Observational studies and pooled data from RCTs demonstrate poor adherence and persistence to oral migraine prophylaxis.

0 comments Cited 142 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial

Robert Croop, Peter J Goadsby, David A Stock … (2019)

0 comments Cited 134 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Hans Christoph Diener: (View ORCID Profile)

Arne May: (View ORCID Profile)

Journal

Title: Cephalalgia

Abbreviated Title: Cephalalgia

Publisher: SAGE Publications

ISSN (Print): 0333-1024

ISSN (Electronic): 1468-2982

Publication date Created: March 2024

Publication date (Electronic): March 23 2024

Publication date (Print): March 2024

Volume: 44

Issue: 3

Affiliations

[1 ]Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Germany

[2 ]Department of Systems Neuroscience, University Hamburg, Hamburg, Germany

Article

DOI: 10.1177/03331024241228605

PubMed ID: 38520255

SO-VID: cea38f4a-3778-4008-8d5b-10eb097cb942

License:

https://creativecommons.org/licenses/by-nc/4.0/

History

Data availability:

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.