The clinical and financial impact of oral triptans - an updated meta-analysis

Summary

In a previous meta-analysis we demonstrated that rizatriptan 10 mg is a clinically and cost-effective treatment option in acute migraine, when compared with other available oral triptans. The current paper updates this analysis, to include data for almotriptan and eletriptan.

A literature search identified all placebo-controlled randomised clinical trials involving oral triptans published up to February 2002. The proportion of patients rendered pain-free over 2 hours was identified for each agent, and the results pooled using a random-effects model. Numbers needed to treat (NNT) were calculated for each agent. Using current UK drug costs, an estimate of the expenditure required per patient rendered pain free at 2 hours was also made.

Twenty-nine studies, involving 45 active treatment arms were identified. Based on the NNT analysis, significantly more patients achieved pain-free status at 2 hours with rizatriptan 10 mg than with sumatriptan 100 mg (p<0.02), sumatriptan 50 mg (p<0.01) eletriptan 40 mg (p<0.01), zolmitriptan 2.5 mg (p<0.05), almotriptan 12.5 mg (p<0.01) and naratriptan 2.5 mg (p<0.001). There was no significant difference between rizatriptan 10 mg, eletriptan 80 mg and zolmitriptan 5 mg for this endpoint. Based on acquisition costs alone, there was a statistically significant difference between the cost-effectiveness ratios of rizatriptan 10 mg (£14.15) and sumatriptan 100 mg (£37.61; p<0.001), zolmitriptan 5 mg (£33.26; p<0.001), naratriptan 2.5 mg (£32.66; p<0.01), sumatriptan 50 mg (£28.71; p<0.001) and eletriptan 80 mg (£28.17; p<0.001). There was no significant difference between the cost-effectiveness ratios calculated for rizatriptan 10 mg and almotriptan 12.5 mg (£15.06), eletriptan 40 mg (£17.37) and zolmitriptan 2.5 mg (£20.22).

Rizatriptan 10 mg is the only agent studied that demonstrated high levels of both clinical and cost-effectiveness. It can therefore be considered an ideal first-line treatment choice in the management of the acute migraine attack.

Key words: :

• oral triptans
• migraine
• numbers needed to treat analysis
• cost-effectiveness
• pain-free