Almotriptan: a review of 20 years’ clinical experience

ABSTRACT

Introduction: Almotriptan (ALT), a serotonin 5-HT_1B/1D agonist has been used in the acute treatment of migraine with or without aura for 20 years, accumulating data on more than 15,000 patients in studies and from an estimated >150 million treated migraine attacks in daily clinical practice. The last major review of ALT was written almost 10 years ago. The current narrative review provides an overview of the experience gained with almotriptan over that time, and highlights data published in the last decade.

Areas covered: Randomized clinical trials, observational studies, postmarketing studies and meta-analyses involving ALT for the treatment of acute migraine identified through a systematic literature search.

Expert opinion: Triptans are a mainstay of anti-migraine treatment. Findings with ALT over the last 10 years have reinforced the positive efficacy and tolerability results that were reported during the first 10 years following its introduction. In particular, more recent clinical results have confirmed its efficacy in women with menstrual migraine, the usefulness of early intervention, long-term benefit in adults, and also its efficacy and safety in adolescents. Overall, ALT can be considered an optimal choice for managing acute migraine resistant to first-line drugs.

KEYWORDS:

• Acute treatment
• almotriptan
• efficacy
• migraine
• tolerability
• triptans

Article highlights

• ALT, a potent and selective 5-HT_1B/1D receptor agonist, is well established for the treatment of acute migraine with or without aura. Newer findings have reinforced the results of earlier studies.

• A dosage of 12.5 mg provides an optimal balance of both pain control and tolerability.

• In clinical trials in patients with migraine pain of moderate/severe intensity, ALT improved outcomes significantly versus placebo, including 2-h pain relief, 2-h pain free, sustained pain free, sustained pain free with no adverse events, and migraine-related symptoms.

• Other trials showed that early administration of ALT (<1 h when pain was mild) provided better clinical outcomes than later administration.

• ALT demonstrated similar short-term efficacy to other triptans including sumatriptan, zolmitriptan and frovatriptan in comparative clinical trials.

• ALT has been shown to be effective in women with menstrual migraine, adolescents, triptan-naïve and triptan-experienced patients, patients with a poor response to sumatriptan, and patients with allodynia.

• ALT is well tolerated with a low incidence of adverse events, aligned with the best tolerated triptans such as naratriptan. At a dose of 12.5 mg the overall incidence of adverse events in clinical trials with ALT was similar to that seen with placebo.

• Studies in real-world settings have supported the effectiveness and tolerability of ALT for the treatment of patients with acute migraine.

• During the last decade since we last reviewed ALT, large numbers of patients and migraine attacks have been treated with the drug; this not only confirms the confidence it inspires in both physicians and patients, it also supports its role as an evidence-based treatment choice for the management of migraine.

Acknowledgments

The authors thank Kathy Croom and Steve Clissold Content Ed Net (Madrid) for editorial assistance that was funded Almirall S.A., Barcelona, Spain.

Declaration of interest

C Vila is an employee of Almirall S.A., Barcelona, Spain. J Pascual has received honoraria as a speaker for Allergan, Lilly, Novartis-Amgen, Stendhal and Teva in the last 5 years. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Editorial assistance was funded by Almirall S.A., Barcelona, Spain.