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Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials.
Cephalalgia. 2006 Feb; 26(2):98-106.C

Abstract

A migraineur can claim to be an infrequent responder ('non-responder') to an oral triptan independent of which triptan he or she is presently using. Four trials of an alternative triptan (zolmitriptan/rizatriptan; eletriptan; naratriptan; almotriptan) in patients with a history of infrequent response to oral sumatriptan were compared and contrasted in terms of study design, patient characteristics, and efficacy and tolerability of the triptan under investigation. Unfortunately, none of the reported studies used an appropriate parallel design, which would have had the non-responding triptan (oral sumatriptan) in one arm and without encapsulation. While the four trials differed in terms of study design (open-label vs. placebo-controlled), definition of sumatriptan 'non-responder' (retrospective vs. prospective) and pain intensity at baseline (30% severe to 70% severe), all four demonstrated that lack of response to sumatriptan did not predict lack of response to an alternative triptan. Changing triptans resulted in 2-h pain-relief rates of 25-81% in patients with a history of poor response to sumatriptan. It can be concluded that migraine patients who respond infrequently to sumatriptan should be switched to a different triptan, as lack of response to one triptan does not predict likelihood of responsiveness to another. A review of the available evidence suggests that almotriptan may be one of the most appropriate choices for an alternative triptan.

Authors+Show Affiliations

Gothenburg Migraine Clinic, Gothenburg, Sweden. carl.dahlof@migraineclinic.se

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

16426262

Citation

Dahlöf, C G H.. "Infrequent or Non-response to Oral Sumatriptan Does Not Predict Response to Other Triptans--review of Four Trials." Cephalalgia : an International Journal of Headache, vol. 26, no. 2, 2006, pp. 98-106.
Dahlöf CG. Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials. Cephalalgia. 2006;26(2):98-106.
Dahlöf, C. G. (2006). Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials. Cephalalgia : an International Journal of Headache, 26(2), 98-106.
Dahlöf CG. Infrequent or Non-response to Oral Sumatriptan Does Not Predict Response to Other Triptans--review of Four Trials. Cephalalgia. 2006;26(2):98-106. PubMed PMID: 16426262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials. A1 - Dahlöf,C G H, PY - 2006/1/24/pubmed PY - 2006/3/30/medline PY - 2006/1/24/entrez SP - 98 EP - 106 JF - Cephalalgia : an international journal of headache JO - Cephalalgia VL - 26 IS - 2 N2 - A migraineur can claim to be an infrequent responder ('non-responder') to an oral triptan independent of which triptan he or she is presently using. Four trials of an alternative triptan (zolmitriptan/rizatriptan; eletriptan; naratriptan; almotriptan) in patients with a history of infrequent response to oral sumatriptan were compared and contrasted in terms of study design, patient characteristics, and efficacy and tolerability of the triptan under investigation. Unfortunately, none of the reported studies used an appropriate parallel design, which would have had the non-responding triptan (oral sumatriptan) in one arm and without encapsulation. While the four trials differed in terms of study design (open-label vs. placebo-controlled), definition of sumatriptan 'non-responder' (retrospective vs. prospective) and pain intensity at baseline (30% severe to 70% severe), all four demonstrated that lack of response to sumatriptan did not predict lack of response to an alternative triptan. Changing triptans resulted in 2-h pain-relief rates of 25-81% in patients with a history of poor response to sumatriptan. It can be concluded that migraine patients who respond infrequently to sumatriptan should be switched to a different triptan, as lack of response to one triptan does not predict likelihood of responsiveness to another. A review of the available evidence suggests that almotriptan may be one of the most appropriate choices for an alternative triptan. SN - 0333-1024 UR - https://www.unboundmedicine.com/medline/citation/16426262/Infrequent_or_non_response_to_oral_sumatriptan_does_not_predict_response_to_other_triptans__review_of_four_trials_ DB - PRIME DP - Unbound Medicine ER -