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Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis.
Headache. 2015 Jul-Aug; 55 Suppl 4:221-35.H

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

INTERPRETATION/CONCLUSIONS

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. University of Ottawa Heart Institute, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.

University of Ottawa Heart Institute, Ottawa, Canada.

Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.

School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. CADTH, Ottawa, Canada.

School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. University of Ottawa Heart Institute, Ottawa, Canada.

MeSH

Anti-Inflammatory Agents, Non-SteroidalDrug Administration ScheduleHumansMigraine DisordersOxazolidinonesRandomized Controlled Trials as TopicSerotonin 5-HT1 Receptor AgonistsTreatment OutcomeTryptamines

Pub Type(s)

Journal Article

Meta-Analysis

Research Support, Non-U.S. Gov't

Review

Systematic Review

Language

eng

PubMed ID

26178694

Citation

Cameron, Chris, et al. "Triptans in the Acute Treatment of Migraine: a Systematic Review and Network Meta-Analysis." Headache, vol. 55 Suppl 4, 2015, pp. 221-35.

Cameron C, Kelly S, Hsieh SC, et al. Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. Headache. 2015;55 Suppl 4:221-35.

Cameron, C., Kelly, S., Hsieh, S. C., Murphy, M., Chen, L., Kotb, A., Peterson, J., Coyle, D., Skidmore, B., Gomes, T., Clifford, T., & Wells, G. (2015). Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. Headache, 55 Suppl 4, 221-35. https://doi.org/10.1111/head.12601

Cameron C, et al. Triptans in the Acute Treatment of Migraine: a Systematic Review and Network Meta-Analysis. Headache. 2015 Jul-Aug;55 Suppl 4:221-35. PubMed PMID: 26178694.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. AU - Cameron,Chris, AU - Kelly,Shannon, AU - Hsieh,Shu-Ching, AU - Murphy,Meghan, AU - Chen,Li, AU - Kotb,Ahmed, AU - Peterson,Joan, AU - Coyle,Doug, AU - Skidmore,Becky, AU - Gomes,Tara, AU - Clifford,Tammy, AU - Wells,George, Y1 - 2015/07/14/ PY - 2015/04/21/accepted PY - 2015/7/17/entrez PY - 2015/7/17/pubmed PY - 2016/2/13/medline KW - benefit KW - efficacy KW - migraine KW - network meta-analysis KW - systematic review KW - triptan SP - 221 EP - 35 JF - Headache JO - Headache VL - 55 Suppl 4 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. INTERPRETATION/CONCLUSIONS: 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. SN - 1526-4610 UR - https://www.unboundmedicine.com/medline/citation/26178694/Triptans_in_the_Acute_Treatment_of_Migraine:_A_Systematic_Review_and_Network_Meta_Analysis_ DB - PRIME DP - Unbound Medicine ER -