Abstract & Commentary
Source: Farkklia M, et al. Eletriptan for the treatment of migraine in patients with previous poor response to oral sumatriptan. Cephalalgia. 2003;23:463-471.
The triptan wars are heating up with 7 competitors now on the market all backed by the heaviest of the pharma heavyweights. Unfortunately, the overall migraine market has not expanded — meaning far too few migraine patients are being diagnosed and adequately treated. Hence, the pharmaceutical industry has been left trying to capture the triptan market share from one another. Despite, or perhaps in spite of, the soaring pharmaceutical marketing budgets, clinicians remain wondering, "Which is the best triptan?" And the answer is, "None of them." That is to say, they all work and they all work well. It just depends upon the patient. As with other large therapeutic categories, efficacies among similar drugs are most dependent upon variability between individuals.
As such, we report on the findings of Farkkila and colleagues looking at eletriptan response rates in a cohort of migraine patients previously unresponsive or intolerant to sumatriptan. In a double-blind, placebo-controlled, parallel-group, multicenter study using usual headache study end points, 446 total patients were evenly divided into 40 mg, 80 mg, and placebo groups and followed for up to 3 migraine attacks. As stated, all these patients had proven intolerant by side effects or unresponsive to sumatriptan. Two-hour pain relief response was 59% for 40 mg and 70% for 80 mg compared to 30% for placebo (P < .0001). Consistency of response was observed in at least 2 of 3 attacks in 66% (40 mg) and 72% (80 mg) vs 15% for placebo (P < .001). Discontinuation rates for side effects were infrequent to none but nausea, asthenia, and chest pain were reported < 10%.
Commentary
So does this prove eletriptan is better than sumatriptan? No, of course not. Both are good triptans and both work well in the patients for whom they work. One may quibble about exactly how "sumatriptan intolerance or unresponsiveness" was defined. But that would lose sight of the forest. The bigger theme here is that patients do well with triptans, and if they fail one they should be given trials of the others until they respond. We at the Cornell Headache Service welcome both eletriptan into the headache armamentarium for patients unresponsive to sumatriptan, as well as sumatriptan for patients unresponsive to eletriptan. — Jeffrey Reich, MD, Assistant Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, Assistant Editor, Neurology Alert.
The triptan wars are heating up with 7 competitors now on the market all backed by the heaviest of the pharma heavyweights, and clinicians wonder, Which is the best triptan? This study looked at eletriptan response rates in a cohort of migraine patients previously unresponsive or intolerant to sumatriptan.
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