Therapeutic applications for subcutaneous triptans in the acute treatment of migraine

Abstract

Background:

The features of migraine attacks and the contexts in which migraine attacks occur vary from attack to attack and from patient to patient. Current treatment strategies, which are dominated by the use of oral forms of migraine medication, do not address this patient-to-patient and attack-to-attack heterogeneity. While current therapies, and, in particular, oral triptan tablets can be effective for many types of migraine attacks that a patient can experience, they may not be the optimum treatment for every migraine in every patient.

Scope:

This clinical review of subcutaneous sumatriptan discusses its characteristics, efficacy, and tolerability and considers its place in clinical practice. The review focuses particularly on several specific clinical settings in which subcutaneous sumatriptan might be a more appropriate therapeutic choice than the oral triptan tablet.

Findings:

Of the triptan formulations, subcutaneous sumatriptan is the most rapidly absorbed and demonstrates a favorable pharmacokinetic profile. Data from randomized, double-blind, clinical trials and studies of patients’ perceptions and preferences suggest that subcutaneous sumatriptan can be particularly useful to help restore normal work functioning, for migraine attacks that cannot be treated early in their course, for migraine attacks associated with gastrointestinal symptoms, such as nausea or vomiting, and for difficult-to-treat migraines, including early-morning migraine and menstrual migraine. The majority of patients (9 in 10) trying subcutaneous sumatriptan indicated that they will use it again. Patients not fully satisfied with previous triptan therapy reported enhanced satisfaction with, and confidence in, treatment after trying subcutaneous sumatriptan.

Conclusions:

By virtue of their availability as multiple compounds and in multiple formulations including oral, intranasal, and injectable forms, triptans can be used to customize migraine therapy to the individual patient and the individual migraine attack. Due to its route of delivery and favorable pharmacokinetic profile, subcutaneous triptans may represent an attractive alternative for specific clinical settings. Subcutaneous sumatriptan can play a key role in maximizing likelihood of pain-free response and rapid return to normal daily activities and, as such, should be considered an important part of the treatment armamentarium for migraine.

Key words::

• Injection
• Subcutaneous
• Sumatriptan
• Triptans

Transparency

Declaration of funding

The SUMAVEL DosePro study described in this manuscript was funded by Zogenix Inc.

Declaration of financial/other relationships

K.E. has received Speaker’s Bureaus honoraria from Zogenix. J.W. has disclosed that she has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors acknowledge Stephen Farr PhD (Zogenix, Inc.), Cynthia Robinson PhD (Zogenix, Inc.) and Synteract Inc., Carlsbad, CA, USA for various responsibilities relating to the management and Good Clinical Practices compliance for the SUMAVEL DosePro study mentioned in this manuscript, and especially Heather Bentley (Clinical Study Manager), Carol Wong PhD (Biostatistician), and Roya Hooshmand-Rad MD PhD (Medical Monitor). The authors acknowledge Jane Saiers PhD (The WriteMedicine, Inc.) for assistance with writing the manuscript. Dr. Saiers’ work was funded by Medical Leverage, a Communications Company.