Triptans and migraine: advances in use, administration, formulation, and development

ABSTRACT

Introduction: Recent triptan development has focused on new administration methods and formulations, triptan combination therapies, treatment in menstrually related migraines, and novel serotonin receptor subtype agonists (5HTf).

Areas covered: Clinical triptan research related to migraine was reviewed, analyzing EMBASE and PUBMED data bases from 01/01/2011 to 06/29/2016, with a focus on clinical trials of class 1 or 2 level of evidence. There have been advances in drug combination therapies, as well as administration devices that aid in ease of use, increase efficacy, and decrease adverse reactions. Some new agents and devices have similar or less efficacy compared to previous generic triptan formulations. New agents have action at the 5HTf receptor subtype, and avoid vascular side effects of classic 5Ht1b/d agonists, however adverse reactions may limit their clinic use. Long half-life triptans, frovatriptan and naratriptan, do appear to have good benefit in menstral related migraine.

Expert opinion: Recent advances in triptan development can offer some advantages to migraine therapy and patient preferences, but have a much higher cost compared to individual generic triptan agents. In the coming years, triptan advances with high efficacy, limiting ADRs and cost are welcomed, in this regard the 5HT1b/d triptans are already well established.

KEYWORDS:

• Triptan
• migraine
• sumatriptan
• naratriptan
• frovatriptan
• naproxen
• dexketoprofen
• lasmiditan
• administration
• device
• menstrual migraine

Article highlights

• Formulation combining triptans with NSAIDS appears to have a positive benefit on treating acute migraine pain. However, comparison to placebo (rather than triptans or NSAIDs alone) in some studies may exaggerate benefit, and higher cost is a concern.

• Alternative routes of administration and devices may bypass oral or injection obstacles, improve pharmacokinetics, and cater to patient preferences. In the end, the medication’s mechanism is the same but the delivery may be improved, and this can improve efficacy.

• New agents have action at the 5HTf receptor subtype (lasmiditan), and avoid the vascular side effects of classic 5Ht1b/d agonists, however dizziness and paresthesias may limit their clinic use.

• In patients who experience increased incidence of migraine headaches reliably during menses, frovatriptan or naratriptan can be considered as prophylactic therapy.

• While several triptans are approved for migraine treatment in children, clinical trials have mixed results and inconsistencies. This stems from inherent difficulties of pediatric pain syndromes and subjective reporting. Future studies may employ alternative design that better suits children.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.