Some triptans are a more effective treatment for acute migraines than newer, more expensive drugs, finds an analysis of the latest evidence published by The BMJ today.
Triptans work by narrowing blood vessels in the brain and preventing the release of chemicals that cause pain and inflammation.
The findings show that four triptans - eletriptan, rizatriptan, sumatriptan, and zolmitriptan - were better at relieving migraine pain than the recently marketed and more expensive drugs lasmiditan, rimegepant, and ubrogepant, which were comparable to paracetamol and most anti-inflammatory painkillers (NSAIDs).
The researchers argue that triptans are currently widely underused, and say access to the most effective triptans should be promoted globally and international guidelines updated accordingly.
Migraine affects more than one billion people worldwide and is the leading cause of disability in girls and women aged 15 to 49 years. Numerous drugs are available, but there’s no clear consensus about which ones perform best.
To address this, researchers trawled scientific databases to identify randomised controlled trials published up to 24 June 2023 that compared licensed oral drugs for treatment of acute migraine in adults.
A total of 137 randomised controlled trials comprising 89,445 participants (average age 40, 86% women) allocated to one of 17 individual drugs or placebo were included. The trials were of varying quality, but the researchers were able to assess the certainty of evidence using a recognised tool.
The results show that all drugs were more effective than placebo at relieving pain after two hours and most were effective for sustained pain relief up to 24 hours, except paracetamol and naratriptan.
When drugs were compared with each other, eletriptan was the most effective drug for pain relief at two hours, followed by rizatriptan, sumatriptan, and zolmitriptan. For sustained pain relief up to 24 hours, the most effective drugs were eletriptan and ibuprofen.
The researchers point out that the best performing triptans should be considered the treatment of choice for migraine episodes and should be included into the WHO Model List of Essential Medicines to promote global accessibility and uniform standards of care.
They acknowledge that some people can’t take triptans due to heart problems or unpleasant side effects.
Nevertheless, they say these results, even if limited to average treatment effects due to the lack of individual patient data, “offer the best available evidence to guide the choice of acute oral drug interventions for migraine episodes” and “should be used to guide treatment choices, promoting shared, informed decision making between patients and clinicians.”
[Ends]
Journal
The BMJ
Method of Research
Systematic review
Subject of Research
People
Article Title
Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis
Article Publication Date
18-Sep-2024
COI Statement
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: WKK has received an educational fee from Pfizer outside of the submitted work. EGO is supported by the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Centre (NIHR203316) and the Lundbeck Foundation Applied Research Collaboration Oxford and Thames Valley at Oxford Health National Health Service Foundation Trust, by the NIHR Oxford Cognitive Health Clinical Research Facility, by the NIHR Oxford Health Biomedical Research Centre, by the Brasenose College Senior Hulme Scholarship, and has also received research and consultancy fees from Angelini Pharma. ZAZ has received a scholarship grant from Rigshospitalet. LK has received a research grant from the Lundbeck Foundation (R155– 2014–171). RHC has received support for travel from the Augustinus Foundation. HMA have received an educational fee from Pfizer outside of the submitted work. CID has received an International Headache Society research fellowship grant, a Hellenic Neurology Society scholarship, support for travel from Merck Serono, and is a member of the European Headache Federation. AT has received research and consultancy fees from Angelini Pharma, INCiPiT (Italian Network for Paediatric Trials), and Takeda; and has also acted as a Clinical Advisor to Akrivia Health. HA reports personal fees from Lundbeck, Pfizer, and Teva outside of the submitted work. ERT is the current executive director and the past president of the European Migraine and Headache Alliance. HCD received honorariums for participation in clinical trials, contribution to advisory boards or oral presentations from: AbbVie, Lilly, Lundbeck, Novartis, Pfizer, Teva, Weber & Weber, and WebMD. The German Research Council (DFG) and the German Ministry of Education and Research (BMBF) support headache research by HCD. HCD serves on the editorial boards of Cephalalgia, Lancet Neurology, and Drugs. AC is supported by the NIHR Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration, by the NIHR Oxford Health Biomedical Research Centre (grant NIHR203316), and by the Wellcome Trust (GALENOS Project); AC has also received research, educational, and consultancy fees from INCiPiT (Italian Network for Paediatric Trials), CARIPLO Foundation, Lundbeck, and Angelini Pharma. MA is a consultant, speaker, or scientific advisor for AbbVie, Amgen, Astra Zeneca, Eli Lilly, GlaxoSmithKline, Lundbeck, Novartis, Pfizer, and Teva; a primary investigator for ongoing AbbVie and Pfizer trials; and is the past president of the International Headache Society; MA is supported through the Lundbeck Foundation professor grant (R310-2018-3711) and serves as associate editor of the Journal of Headache and Pain, and associate editor of Brain.