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Eletriptan in acute migraine

A double-blind, placebo-controlled comparison to sumatriptan

From the Institute of Neurology (Dr. Goadsby), The National Hospital for Neurology and Neurosurgery, London; the Department of Neurology (Dr. Ferrari), The Leiden University Medical Centre, the Netherlands; the Department of Neurology (Dr. Olesen), KAS Glostrup Denmark; Nevrologisk Avdeling RIT (Dr. Stovner), Trondheim Norway; Service de Neurologie (Dr. Senard), Hôpital de Purpan, Toulouse France; Pfizer Central Research (Dr. Jackson and P.H. Poole), Sandwich, Kent, UK.

Address correspondence and reprint requests to Prof. P.J. Goadsby, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; e-mail: peterg{at}brain.ion.ucl.ac.uk

OBJECTIVE: To compare the efficacy, safety, and tolerability of oral eletriptan (20 mg, 40 mg, and 80 mg) with that of oral sumatriptan (100 mg) and placebo for the acute treatment of migraine.

BACKGROUND: Eletriptan is a potent and selective agonist at human recombinant 5HT_1B/1D receptors, with efficacy in animal models that predict antimigraine activity. In healthy volunteers, the pharmacokinetics of eletriptan are characterized by linear and rapid oral absorption.

METHODS: Randomized, double-blind, parallel-group study conducted in 857 outpatients with a diagnosis of migraine according to the International Headache Society (IHS) criteria. Of these, 692 took study medication for one acute migraine attack and provided on-drug efficacy data. Subjects received either placebo, 100 mg of sumatriptan or 20 mg, 40 mg, or 80 mg of eletriptan for the treatment of an acute migraine attack. The primary endpoint was the percentage of patients with a headache response (improvement in pain intensity from moderate or severe to mild or none) at 2 hours after treatment.

RESULTS: At the primary endpoint (2 hours after dosing), headache response rates were 24% (30/126) for placebo; 55% (63/115) for sumatriptan, 100 mg; 54% (70/129) for eletriptan, 20 mg; 65% (76/117) for eletriptan, 40 mg; and 77% (91/118) for eletriptan, 80 mg. There was a difference compared with placebo (p < 0.001) for all doses of eletriptan, and at 2 hours there was a difference between sumatriptan, 100 mg, and eletriptan, 80 mg (p < 0.001). Headache-free rates at 2 hours were superior to placebo (6%; p < 0.001) for both the 80-mg dose of eletriptan (37%) and the 40-mg dose (29%), with the 80-mg dose also being superior to 100 mg of sumatriptan (23%; p < 0.05). Eletriptan and sumatriptan were well tolerated, and the majority of adverse events were mild or moderate in intensity and transient.

CONCLUSION: In this placebo-controlled trial, eletriptan, at selected doses, demonstrated superior efficacy, onset of action and patient acceptability in the acute treatment of migraine when compared with oral sumatriptan and placebo.

Key words: Eletriptan—Sumatriptan—Triptan—Migraine—Acute treatment—Headache

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