Switching Triptans Can Improve Outcomes for Migraine Sufferers

Paula Moyer, MA

October 19, 2006

October 19, 2006 (Chicago) — Migraine sufferers who are triptan experienced frequently report better effectiveness and tolerability when they switch to another triptan, according to a team of investigators who presented their findings here at the American Neurological Association 131st Annual Meeting.

"Patients not responding adequately to their current triptan may achieve improved outcomes by switching to another triptan," senior investigator Arnold R. Gammaitoni, PharmD, said in a presentation . "In this study patients who switched to frovatriptan ( Frova) reported higher ratings of effectiveness and tolerability compared with their previous regimen."

Dr. Gammaitoni is the manager of medical affairs at Endo Pharmaceuticals Inc, in Chadds Ford, Pennsylvania, which manufactures Frova and which sponsored the presentation. The research was support by Berlin-Chemie, which markets Frova in Europe.

The investigators wanted to know whether patients who had been previously taking triptans had a preference within that class. They conducted a retrospective subanalysis of 2437 patients who had previously been taking triptans other than frovatriptan for acute treatment of migraine. Study subjects had previously participated in a postmarketing observational study that had involved 7107 German patients who had begun taking frovatriptan.

On average, patients were 44.1 years old and 85.1% were women, a typical finding in migraine studies. In this subset, 54.3% patients had at least 3 attacks per month, and one third of their attacks lasted more than 24 hours.

At baseline, 39% of patients rated their treatment effectiveness as good or very good; after the switch to frovatriptan, that rate increased to 84%. Most (60%) gave their original triptan a tolerability rating of good to very good. After the switch, however, this rate increased to 93%. Among those who had given their prior treatment an effectiveness score that was less than good, 85% gave frovatriptan a score of good or very good. Among those who gave their baseline medication a tolerability rating of less than good, 98% rated frovatriptan's tolerability as good or very good.

"This study complements what we see on an anecdotal basis. In our clinics, treatment with 1 triptan is initially very good, but not as good over time. But when you switch to another triptan, the patient gets better," said Victoria Pelak, MD, in a phone interview seeking outside comment.

Dr. Pelak, who was not involved in the study, is an associate professor of neurology and ophthalmology at the University of Colorado Hospitals in Denver.

"Also, when patients don't have a good response to the first triptan, they often have a better response with another," she continued. "We have to remember that the investigators looked only at people who had been using other triptans. What about people who had been taking frovatriptan who switched to another triptan? The key is that patients should be advised not to give up on the triptans, because we can often find another one that they'll respond to. The finding is probably more related to switching from 1 triptan to any other triptan, rather than switching to frovatriptan."

ANA 131st Annual Meeting: Abstract #M-90. Presented October 9, 2006.

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