Network meta-analysis of migraine disorder treatment by NSAIDs and triptans

Abstract

BackgroundMigraine is a neurological disorder resulting in large socioeconomic burden. This network meta-analysis (NMA) is designed to compare the relative efficacy and tolerability of non-steroidal anti-inflammatory agents (NSAIDs) and triptans.MethodsWe conducted systematic searches in database PubMed and Embase. Treatment effectiveness was compared by synthesizing direct and indirect evidences using NMA. The surface under curve ranking area (SUCRA) was created to rank those interventions.ResultsEletriptan and rizatriptan are superior to sumatriptan, zolmitriptan, almotriptan, ibuprofen and aspirin with respect to pain-relief. When analyzing 2 h-nausea-absence, rizatriptan has a better efficacy than sumatriptan, while other treatments indicate no distinctive difference compared with placebo. Furthermore, sumatriptan demonstrates a higher incidence of all-adverse-event compared with diclofenac-potassium, ibuprofen and almotriptan.ConclusionThis study suggests that eletriptan may be the most suitable therapy for migraine from a comprehensive point of view. In the meantime ibuprofen may also be a good choice for its excellent tolerability. Multi-component medication also attracts attention and may be a promising avenue for the next generation of migraine treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0703-0) contains supplementary material, which is available to authorized users.

Almotriptan: a review of 20 years’ clinical experience

“…Another meta-analysis of data for the same six triptans found that ALT 12.5 mg had the highest rate of sustained pain-free with no adverse events [38]. Two more recent meta-analyses used multiple treatment comparison metaanalysis (n = 74 trials covering seven triptans including frovatriptan) or network meta-analysis (n = 88 trials covering six triptans) to incorporate indirect evidence [39,40]. Both found that eletriptan and rizatriptan provided better 2-h pain free response than other triptans, including ALT [39,40].…”

“…Two more recent meta-analyses used multiple treatment comparison metaanalysis (n = 74 trials covering seven triptans including frovatriptan) or network meta-analysis (n = 88 trials covering six triptans) to incorporate indirect evidence [39,40]. Both found that eletriptan and rizatriptan provided better 2-h pain free response than other triptans, including ALT [39,40]. One also evaluated sustained pain-free response at 24 h, and ranked ALT as third most likely to be the best for this endpoint after eletriptan and zolmitriptan [39].…”

Therapie der Migräneattacke und Prophylaxe der Migräne

“…Alle Triptane haben ihre Wirkung in großen placebokontrollierten Studien belegt. Die in klinischen Studien erhobenen Daten zur Wirksamkeit der oralen Triptane sind in großen Metaanalysen zusammengefasst worden, sodass diese Studien hier nicht im Einzelnen referiert werden (19)(20)(21)(22)(23)(24). Für die verschiedenen nicht oralen Applikationsformen von Sumatriptan liegen Cochrane-Analysen vor, die ebenfalls eine Wirksamkeit zeigen (25)(26)(27)(28).…”

Acute treatment of migraine: quo vadis?

“…Afterwards, researchers' attention was driven towards comparing the effectiveness of the seven triptan brothers, alone or in combination with NSAIDs. The debate revolved around safety, efficacy, consistency, drugdrug interactions with prophylactic drugs, pharmacokinetics/ pharmacodynamics, new delivery pathways, extension of this pharmacological class to the population aged under 18 or over 65 years, evaluation of common adverse events, disability levels [6][7][8][9][10][11][12]. Notwithstanding, only 27% of migraine patients receive a correct diagnosis and only 17% of them takes triptans for a crisis [13,14].…”