Pharmacoepidemiology of triptans in a headache centre

The efficacy and safety of triptans in the absence of contraindications have been proved. Nevertheless, these drugs are not much used in clinical practice [1], while they are the most commonly used class of medication in the specialty care [2]. The aims of our study were: (i) examining the pharmacoepidemiology of triptans in the population of migraine patients treated at a specialist centre; (ii) analysing if there were any differences among patients continuing to use triptans and patients that, after having tried these drugs, discontinued them. Methods. We examined all migraine patients, according to International Classification of Headache Disorders 2nd edition criteria [3], older than 18, consecutively examined for a follow-up visit at the ambulatories of the Headache Centre of the University Hospital of Modena from October 2008 to March 2009. Only patients who had used/used triptans as abortive treatments were included. A questionnaire with closed and open questions about the use and tolerability of triptans was prepared for the study. The questionnaire was administered in the waiting room by a trained a postgraduated student of the School of Clinical Pharmacology, who had never examined the patients before. Results. 343 migraine patients (F: 75%, M: 25%; mean age 40.4+10.3 years) reported to have used/use triptans. Migraine without aura (n=247, 72%) was the most common diagnosis, followed by chronic migraine (n=90, 26%) and migraine with aura (n=6, 2%). Globally, 60% (n=206) of the sample had tried at least two triptans and 72 % (n=246) continued to use them habitually. The patients who had discontinued triptans (97/343, 28%) were significantly younger (mean age 36.8+6 years), had been suffering from migraine for less years (7.6+4), and had less migraine days/month (7.7+6) than those who instead continued to use them (mean age 41.8+1 years; years of migraine 15.5+9; migraine days/month: 13.4+1; P <0.0001, Student's t-test for unpaired data). Much more patients among those who had discontinued triptans (89/97, 92%) than among those who continued to use them (139/246, 57%) reported triptan-associated side effects (P <0.0001, Fisher’s exact test). Most patients who had discontinued triptans (57/97, 59%) had taken this decision precisely because of side effects. The decision to continue to use triptans had instead been taken by most patients because of their efficacy (210/246, 85%). The most used triptans had been sumatriptan (66%), almotriptan (54%), and rizatriptan (47%). The triptan discontinued by the highest percentage of the patients who had used it (31/37, 84%) had been sumatriptan 6 mg subcutaneous injection. Rizatriptan 10 mg had been significantly more discontinued (85/113, 75%) than sumatriptan 50 mg (28/71, 39%), almotriptan (84/146, 45%), zolmitriptan (44/78, 56%), and rizatriptan 5 mg (23/49, 47%) (P<0.05, Chi-square test). Significantly more patients reported side effects with sumatriptan 6 mg subcutaneous injection (33/37, 89%) and 100 mg tablet (50/75, 67%) than with any other triptan. No patient reported serious or unexpected adverse triptan-associated effects. The most common side effects were the so-called “triptan sensations”, i.e., a feeling of drowsiness (47%) and of neck or chest tightness (36%). Conclusions. In general, the patient decides to take a given drug depending on the balance between awaited benefits and potential risks. Most migraine patients going to a specialist centre continue to use triptans, after having tried them, above all for their efficacy. The minority discontinuing them are younger patients, who have been suffering from less severe migraine and for less time. These younger migraine patients seem inclined to consider the cost to pay in terms of worrisome, but non-serious side effects, unacceptable if compared to the benefits of the use of triptans. References [1] MacGregor E.A., Brandes J., Eikermann A. (2003). Migraine prevalence and treatment patterns: the global migraine and zolimitriptan evaluation survey. Headache 243: 19-26 [2] Bigal M., Rapoport A., Aurora S. et al. (2007). Satisfaction with current migraine therapy: experience from 3 centers in US and Sweden. Headache 47: 475-479 [3] Headache Classification Subcommittee of the International Headache Society (2004). The International Classification of Headache Disorders, 2nd edn. Cephalalgia 24.(Suppl 1):1-160