Comparison of Preference for Rizatriptan 10-mg Wafer versus Sumatriptan 50-mg Tablet in Migraine

Abstract

Rizatriptan (MAXALT^TM, a registered trademark of Merck & Co. Inc.) is a selective 5-HT_1B/1D receptor agonist with rapid oral absorption and early onset of action in the acute treatment of migraine. This randomized, open-label, crossover outpatient study assessed the preference of 481 patients for rizatriptan 10-mg rapidly disintegrating tablets versus sumatriptan (IMIGRAN^TM, a registered trademark of GlaxoWellcome PLC) 50-mg tablets in the treatment of a single migraine attack with each therapy. Almost twice as many patients preferred rizatriptan 10-mg rapidly disintegrating tablet to sumatriptan 50-mg tablet (64.3 vs. 35.7%, p ≤ 0.001). Faster relief of headache pain was the most important reason for the preference, cited by 46.9% of patients preferring rizatriptan and 43.4% of patients who preferred sumatriptan. Headache relief at 2 h was 75.9% with rizatriptan and 66.6% with sumatriptan (p ≤ 0.001), with rizatriptan being superior to sumatriptan within 30 min of dosing. Fifty-five percent of patients were pain free 2 h after rizatriptan, compared with 42.1% treated with sumatriptan (p ≤ 0.001), rizatriptan being superior within 1 h of treatment. Forty-one percent of patients taking rizatriptan were pain free at 2 h and had no recurrence or need for additional medication, compared to 32.3% of patients on sumatriptan. Rizatriptan was also superior to sumatriptan in terms of the proportions of patients with no nausea, phonophobia or photophobia, and patients with normal function 2 h after treatment intake (p < 0.05). More patients were (completely, very or somewhat) satisfied 2 h after treatment with rizatriptan (73.3%) than 2 h after treatment with sumatriptan (59.0%) (p ≤ 0.001). Additionally, 2 h after the dose, more patients found rizatriptan to be very convenient, convenient or somewhat convenient (87.2%) than they did sumatriptan (76.3%) (p ≤ 0.001). Both active treatments were well tolerated. The most common side effects with rizatriptan and sumatriptan were nausea (6.6 and 6.9% of patients, respectively), dizziness (6.1 and 5.8%) and somnolence (7.4 and 6.7%).

Crossover Comparison of Efficacy and Preference for Rizatriptan 10 mg versus Ergotamine/Caffeine in Migraine

“…AEs were mostly mild or moderate and transient in nature. The commonest AEs following rizatriptan were similar to those reported in previous studies [1, 2, 14]and consisted of somnolence, dizziness and nausea.…”

“…Likewise, those patients who preferred ergotamine/caffeine to rizatriptan did so for the same reason. The observation that speed of relief is most important to patients has been seen both in a previous open label preference study [14]comparing rizatriptan to sumatriptan and in surveys of migraine patients [15]. Preference is a readily understood concept that translates study data into clinical application and is clinically meaningful to patients.…”

Rizatriptan for the acute treatment of migraine: Consistency, preference, satisfaction, and quality of life

“…Most of the studies were financially sponsored by Merck Frosst, the maker of rizatriptan. 3,4,[6][7][8]10,[12][13][14][15] This bias likely resulted in the preference comparison of rizatriptan to the 50 mg dose of sumatriptan, rather than the 100 mg dose, which may be more effective than the lower dose of sumatriptan in some patients. 26 Furthermore, most studies compared only two attacks -one attack for each medication -which may not be enough time to determine whether a medication is effective and well tolerated.…”

Patient preference in migraine therapy

“…The finding that efficacy is a primary determinant of patient preference is consistent with results from other studies investigating patient preference in migraine. In several preference trials comparing rizatriptan with other triptans or with nontriptan medications, faster onset of headache relief was the most commonly cited reason for preference; other frequently cited reasons were faster return to normal function and greater efficacy [8,13,14].…”