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Comparison of rizatriptan and other triptans on stringent measures of efficacy

From the Headache Wellness Center (Dr. Adelman), Greensboro, NC; Albert Einstein College of Medicine (Dr. Lipton), Bronx, NY; Leiden University Medical Center (Dr. Ferrari), Leiden, The Netherlands; Department of Neurology (Dr. Diener), University of Essen, Germany; and Merck Research Laboratories (Drs. McCarroll, Vandormael, and Lines), West Point, PA.

Address correspondence and reprint requests to Dr. J.U. Adelman, Headache Wellness Center, 301 East Wendover, Greensboro, NC 27401; e-mail: jadelman{at}triad.rr.com

Objective: — To compare the efficacy of oral rizatriptan 10 mg with oral doses of sumatriptan, naratriptan, and zolmitriptan on stringent outcome measures.

Methods: — Retrospective analysis of data from five randomized, placebo-controlled, double-masked clinical trials in which oral rizatriptan was directly compared with oral sumatriptan 100 mg (n = 772), 50 mg (n = 1116), 25 mg (n = 1183), naratriptan 2.5 mg (n = 413), and zolmitriptan 2.5 mg (n = 580) for the acute treatment of a moderate or severe migraine attack.

Outcome measures: — Percentage of patients pain-free at 2 hours, symptom-free at 2 hours (no pain, nausea, photophobia, phonophobia, vomiting, or functional disability), 24-hour sustained pain-free (no headache at 2 hours, no recurrence, and no additional antimigraine medications for 24 hours).

Results: — More patients taking rizatriptan 10 mg were pain-free at 2 hours than were patients taking sumatriptan 100 mg (40% vs 33%, p = 0.019), sumatriptan 50 mg (40% vs 35%, p = 0.009), sumatriptan 25 mg (38% vs 27%, p < 0.001), naratriptan 2.5 mg (45% vs 21%, p < 0.001), and zolmitriptan 2.5 mg (43% vs 36%, p = 0.041). More patients taking rizatriptan 10 mg were symptom-free at 2 hours than were patients taking sumatriptan 100 mg (31% vs 22%, p = 0.002), sumatriptan 50 mg (33% vs 28%, p = 0.003), sumatriptan 25 mg (33% vs 24%, p < 0.001), naratriptan 2.5 mg (30% vs 11%, p < 0.001), and zolmitriptan 2.5 mg (31% vs 24%, p = 0.042). More patients taking rizatriptan 10 mg had a 24-hour sustained pain-free response than did patients taking sumatriptan 100 mg (27% vs 23%, p = 0.112), sumatriptan 50 mg (30% vs 26%, p = 0.015), sumatriptan 25 mg (27% vs 20%, p = 0.005), naratriptan 2.5 mg (29% vs 17%, p = 0.004), and zolmitriptan 2.5 mg (32% vs 24%, p = 0.013).

Conclusion: — Oral rizatriptan 10 mg was more effective than oral sumatriptan, naratriptan, and zolmitriptan on stringent outcome measures of pain-free response at 2 hours, symptom-free response at 2 hours, and 24-hour sustained pain-free response.

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				U K Misra, M Jose, and J Kalita Rofecoxib versus ibuprofen for acute treatment of migraine: a randomised placebo controlled trial Postgrad. Med. J., December 1, 2004; 80(950): 720 - 723. [Abstract] [Full Text] [PDF]

				M. J. Rieder, I. S. Login, J.U. Adelman, R.B. Lipton, M.D. Ferrari, H.C. Diener, K.A. McCarroll, K. Vandormael, and C.R. Lines Comparison of rizatriptan and other triptans on stringent measures of efficacy Neurology, September 10, 2002; 59(5): 787 - 788. [Full Text] [PDF]

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