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Almotriptan in triptan-naïve patients: new evidence of benefits.
Cephalalgia. 2008 Sep; 28 Suppl 2:14-20.C

Abstract

Although triptans represent the standard of care for migraine that is severe, disabling and/or suboptimally responsive to migraine non-specific analgesia, they are often underused in clinical practice. Simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) may provide effective treatment in some patients, but it is an inadequate response to these drugs that drives the therapeutic progression to triptans at the end of the traditional 'step-care' approach. However, there are several disadvantages to this approach. It may cause patients to lose confidence in their physician during this hierarchical 'trial-and-error' search for optimal treatment when prescribed medications are ineffective, leading them to cease consulting before triptans are tried. It may also result in a protracted time interval of suboptimal treatment, with unnecessary suffering in patients who are triptan candidates. The alternative approach of 'stratified care', in which medication is prescribed according to the severity of symptoms, enables triptans to be used earlier in the treatment plan, especially when triptan candidates are given a choice between simple analgesic/NSAID and triptan medication from the start. This raises the question about the efficacy of triptans in triptan-naïve (TN) patients. A recent exploratory post-hoc analysis compared the effect of almotriptan 12.5 mg in TN patients (n = 342) with that in triptan-experienced patients (n = 237). Almotriptan was effective in both cohorts with a consistent trend in favour of the efficacy of almotriptan in TN patients, notably for sustained pain freedom (SPF) and SPF plus no adverse events. Moreover, both headache recurrence at 24 h and the use of rescue medication was lower in the TN patients, whereas tolerability was equally good in both cohorts. These findings indicate that TN patients can expect excellent symptom control when they progress from non-specific analgesia to treatment with almotriptan and support the earlier use of triptans in line with the stratified care paradigm.

Authors+Show Affiliations

University Hospital of Salamanca, Salamanca, Spain. juliopascual@telefonica.net

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18715328

Citation

Pascual, J. "Almotriptan in Triptan-naïve Patients: New Evidence of Benefits." Cephalalgia : an International Journal of Headache, vol. 28 Suppl 2, 2008, pp. 14-20.
Pascual J. Almotriptan in triptan-naïve patients: new evidence of benefits. Cephalalgia. 2008;28 Suppl 2:14-20.
Pascual, J. (2008). Almotriptan in triptan-naïve patients: new evidence of benefits. Cephalalgia : an International Journal of Headache, 28 Suppl 2, 14-20. https://doi.org/10.1111/j.1468-2982.2008.01686.x
Pascual J. Almotriptan in Triptan-naïve Patients: New Evidence of Benefits. Cephalalgia. 2008;28 Suppl 2:14-20. PubMed PMID: 18715328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Almotriptan in triptan-naïve patients: new evidence of benefits. A1 - Pascual,J, PY - 2008/9/6/pubmed PY - 2008/12/17/medline PY - 2008/9/6/entrez SP - 14 EP - 20 JF - Cephalalgia : an international journal of headache JO - Cephalalgia VL - 28 Suppl 2 N2 - Although triptans represent the standard of care for migraine that is severe, disabling and/or suboptimally responsive to migraine non-specific analgesia, they are often underused in clinical practice. Simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) may provide effective treatment in some patients, but it is an inadequate response to these drugs that drives the therapeutic progression to triptans at the end of the traditional 'step-care' approach. However, there are several disadvantages to this approach. It may cause patients to lose confidence in their physician during this hierarchical 'trial-and-error' search for optimal treatment when prescribed medications are ineffective, leading them to cease consulting before triptans are tried. It may also result in a protracted time interval of suboptimal treatment, with unnecessary suffering in patients who are triptan candidates. The alternative approach of 'stratified care', in which medication is prescribed according to the severity of symptoms, enables triptans to be used earlier in the treatment plan, especially when triptan candidates are given a choice between simple analgesic/NSAID and triptan medication from the start. This raises the question about the efficacy of triptans in triptan-naïve (TN) patients. A recent exploratory post-hoc analysis compared the effect of almotriptan 12.5 mg in TN patients (n = 342) with that in triptan-experienced patients (n = 237). Almotriptan was effective in both cohorts with a consistent trend in favour of the efficacy of almotriptan in TN patients, notably for sustained pain freedom (SPF) and SPF plus no adverse events. Moreover, both headache recurrence at 24 h and the use of rescue medication was lower in the TN patients, whereas tolerability was equally good in both cohorts. These findings indicate that TN patients can expect excellent symptom control when they progress from non-specific analgesia to treatment with almotriptan and support the earlier use of triptans in line with the stratified care paradigm. SN - 1468-2982 UR - https://www.unboundmedicine.com/medline/citation/18715328/Almotriptan_in_triptan_naïve_patients:_new_evidence_of_benefits_ L2 - https://journals.sagepub.com/doi/10.1111/j.1468-2982.2008.01686.x?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -