Effectiveness of Eletriptan in Acute Migraine
Effectiveness of Eletriptan in Acute Migraine
Objective: To evaluate the effectiveness of eletriptan as a treatment for acute migraine in patients who were poor responders to Excedrin and had not yet been exposed to a triptan.
Background: Self-medication with over-the-counter drugs, such as Excedrin, is the most common treatment for migraine. Guidelines, however, recommend that triptans be used as first-line treatment of moderate to severe migrainethe severity affecting approximately 80% of migraineurs. Since over-the-counter medications, such as Excedrin, continue to be used in many patients, it is important that clinicians have information on the efficacy of triptans as first-line treatment and on treatment of migraineurs who have shown poor response to over-the-counter medications.
Methods: One hundred ten patients meeting criteria for migraine who were poor responders to Excedrin received open-label treatment with a 40-mg dose of eletriptan for one migraine attack. Efficacy assessments were made at 1, 2, 4, and 24 hours postdose and consisted of headache and pain-free response rates, absence of associated symptoms, and functional response.
Results: At 1 hour, the headache response rate was 44%; at 2 hours, 81%. The pain-free response rate at 1 hour was 14% and at 2 hours, 48%. At 2 hours, relief of baseline-associated symptoms ranged from 74% to 80%. Functional response was achieved by 82% of patients by 2 hours, and 68% of patients achieved relief of migraine that was sustained across 24 hours with no need for a second dose of eletriptan or for rescue medication. Eletriptan was well tolerated with adverse events being transient and mild to moderate in intensity.
Conclusion: Previous studies have established the efficacy of eletriptan as a first-line treatment for migraine. The results of this open-label trial demonstrate that the 40-mg dose of eletriptan had a high degree of efficacy and tolerability among patients who were poor responders to Excedrin.
Despite advances in understanding the pathophysiology of migraine and despite the advent of triptans, a class of drugs that targets underlying mechanisms implicated in migraine, self-medication with over-the-counter (OTC) drugs remains the most common form of treatment for migraine. Two large community surveys, spanning the decade of the 1990s, reported a significant increase (from 38% to 48%) in the percentage of migraineurs who had received a diagnosis from a physician. Yet, in this same survey, the proportion of individuals treating migraine with OTC medication alone remained almost unchanged (59% versus 57%).
Is this level of OTC treatment optimal in view of what is now known about the severity and disability associated with migraine in the community? The practice guidelines of the American Academy of Neurology (AAN) recommend: "use migraine-specific agents (triptans, dihydroergotamine) in patients with moderate or severe migraine, or whose mild-to-moderate headaches respond poorly to NSAIDs [nonsteroidal anti-inflammatory drugs] or combinations such as aspirin plus acetaminophen plus caffeine. Failure to use an effective treatment promptly may increase pain, disability, and the impact of the headache." Data from the most recent national survey indicate that, based on current AAN treatment guidelines, less than 20% of patients would qualify for initial treatment with an OTC medication. Thus, the current rate of OTC medication use (57%) appears to considerably exceed what might be considered optimal patient care.
Of the nonspecific medications utilized in the treatment of migraine, the aspirin/acetaminophen/ caffeine combination analgesic, available as Excedrin, is currently considered the most effective OTC treatment, and is the only OTC medication to receive a combined A (quality of data) and +++ (efficacy) rating in the AAN practice guidelines. A closer examination of the results of the 3 largest well-controlled studies confirms the efficacy of Excedrin for relieving head pain, while highlighting the extent to which the patient sample enrolled represented the milder end of the migraine spectrum. Compared to the intensity of the typical migraine in the community, the treated attacks of patients in the Excedrin study were less likely to be rated as severe (34% versus 81%) and less likely to be associated with functional impairment rated as severe/requiring bed rest (36% versus 52%). Furthermore, Excedrin is notably less effective than a triptan at relieving the associated symptoms of migraine and thus, despite lower pretreatment levels of functional impairment in study patients, functional response rates are lower for Excedrin.
The results of community surveys suggest that full implementation of current treatment guidelines would likely result in triptans being used as first-line treatment for most individuals with migraine. Nonetheless, in the current practice environment, triptans are most commonly prescribed to patients who have not had a satisfactory response to initial treatment with OTC medications. Thus, it is important that clinicians have information on the efficacy of triptans as migraine-specific treatment for those who use OTC medications who may not be achieving optimal response, because while only moderate levels of head pain affect many of these migraineurs, they may have prominent associated symptoms or functional impairment (or both).
Eletriptan is a newer triptan with rapid and consistent absorption, high oral bioavailability, and potent agonist activity at 5-HT1B/1D receptors. It has demonstrated significant efficacy in multiple placebo-controlled trials. Eletriptan has also shown high response rates in patients who were poor responders to previous treatment with NSAIDs, sumatriptan, and Fiorinal/Fioricet. The goal of the current study was to evaluate the effectiveness of eletriptan as a treatment of acute migraine in patients in the primary care setting who had failed to respond adequately to Excedrin, but who had not yet been exposed to a triptan.
Objective: To evaluate the effectiveness of eletriptan as a treatment for acute migraine in patients who were poor responders to Excedrin and had not yet been exposed to a triptan.
Background: Self-medication with over-the-counter drugs, such as Excedrin, is the most common treatment for migraine. Guidelines, however, recommend that triptans be used as first-line treatment of moderate to severe migrainethe severity affecting approximately 80% of migraineurs. Since over-the-counter medications, such as Excedrin, continue to be used in many patients, it is important that clinicians have information on the efficacy of triptans as first-line treatment and on treatment of migraineurs who have shown poor response to over-the-counter medications.
Methods: One hundred ten patients meeting criteria for migraine who were poor responders to Excedrin received open-label treatment with a 40-mg dose of eletriptan for one migraine attack. Efficacy assessments were made at 1, 2, 4, and 24 hours postdose and consisted of headache and pain-free response rates, absence of associated symptoms, and functional response.
Results: At 1 hour, the headache response rate was 44%; at 2 hours, 81%. The pain-free response rate at 1 hour was 14% and at 2 hours, 48%. At 2 hours, relief of baseline-associated symptoms ranged from 74% to 80%. Functional response was achieved by 82% of patients by 2 hours, and 68% of patients achieved relief of migraine that was sustained across 24 hours with no need for a second dose of eletriptan or for rescue medication. Eletriptan was well tolerated with adverse events being transient and mild to moderate in intensity.
Conclusion: Previous studies have established the efficacy of eletriptan as a first-line treatment for migraine. The results of this open-label trial demonstrate that the 40-mg dose of eletriptan had a high degree of efficacy and tolerability among patients who were poor responders to Excedrin.
Despite advances in understanding the pathophysiology of migraine and despite the advent of triptans, a class of drugs that targets underlying mechanisms implicated in migraine, self-medication with over-the-counter (OTC) drugs remains the most common form of treatment for migraine. Two large community surveys, spanning the decade of the 1990s, reported a significant increase (from 38% to 48%) in the percentage of migraineurs who had received a diagnosis from a physician. Yet, in this same survey, the proportion of individuals treating migraine with OTC medication alone remained almost unchanged (59% versus 57%).
Is this level of OTC treatment optimal in view of what is now known about the severity and disability associated with migraine in the community? The practice guidelines of the American Academy of Neurology (AAN) recommend: "use migraine-specific agents (triptans, dihydroergotamine) in patients with moderate or severe migraine, or whose mild-to-moderate headaches respond poorly to NSAIDs [nonsteroidal anti-inflammatory drugs] or combinations such as aspirin plus acetaminophen plus caffeine. Failure to use an effective treatment promptly may increase pain, disability, and the impact of the headache." Data from the most recent national survey indicate that, based on current AAN treatment guidelines, less than 20% of patients would qualify for initial treatment with an OTC medication. Thus, the current rate of OTC medication use (57%) appears to considerably exceed what might be considered optimal patient care.
Of the nonspecific medications utilized in the treatment of migraine, the aspirin/acetaminophen/ caffeine combination analgesic, available as Excedrin, is currently considered the most effective OTC treatment, and is the only OTC medication to receive a combined A (quality of data) and +++ (efficacy) rating in the AAN practice guidelines. A closer examination of the results of the 3 largest well-controlled studies confirms the efficacy of Excedrin for relieving head pain, while highlighting the extent to which the patient sample enrolled represented the milder end of the migraine spectrum. Compared to the intensity of the typical migraine in the community, the treated attacks of patients in the Excedrin study were less likely to be rated as severe (34% versus 81%) and less likely to be associated with functional impairment rated as severe/requiring bed rest (36% versus 52%). Furthermore, Excedrin is notably less effective than a triptan at relieving the associated symptoms of migraine and thus, despite lower pretreatment levels of functional impairment in study patients, functional response rates are lower for Excedrin.
The results of community surveys suggest that full implementation of current treatment guidelines would likely result in triptans being used as first-line treatment for most individuals with migraine. Nonetheless, in the current practice environment, triptans are most commonly prescribed to patients who have not had a satisfactory response to initial treatment with OTC medications. Thus, it is important that clinicians have information on the efficacy of triptans as migraine-specific treatment for those who use OTC medications who may not be achieving optimal response, because while only moderate levels of head pain affect many of these migraineurs, they may have prominent associated symptoms or functional impairment (or both).
Eletriptan is a newer triptan with rapid and consistent absorption, high oral bioavailability, and potent agonist activity at 5-HT1B/1D receptors. It has demonstrated significant efficacy in multiple placebo-controlled trials. Eletriptan has also shown high response rates in patients who were poor responders to previous treatment with NSAIDs, sumatriptan, and Fiorinal/Fioricet. The goal of the current study was to evaluate the effectiveness of eletriptan as a treatment of acute migraine in patients in the primary care setting who had failed to respond adequately to Excedrin, but who had not yet been exposed to a triptan.