An analysis of the latest evidence shows that some triptans are more effective for acute migraines than newer costlier drugs, according to a study in The BMJ. Triptans are known to act by constricting blood vessels in the brain and reducing the release of substances causing pain and inflammation.
According to the findings, the following triptans, eletriptan, rizatriptan, sumatriptan, zolmitriptan and the following drugs were found to be equally effective in managing migraine pain than the newly marketed expensive drugs lasmiditan, rimegepant and ubrogepant which was equivalent to paracetamol and most NSAIDs.
The researchers stress that at present, triptans remain a rather underutilised group of drugs; the authors stated that the access to the most effective triptans must be encouraged worldwide and the existing international guidelines shall be adjusted to this fact. Migraine impacts more than a billion individuals globally and accounts for increased disability in girls and women aged 15 to 49 years.
Many drugs are present, but no studies or comprehensive material indicates which drugs’ performance is the best.
In view of this, the researchers conducted a search of scientific databases to lookup randomised controlled trials conducted up to 24 June 2023 that evaluated licensed oral remedies for migraine treatment in adults.
We identified 137 RCTs with 89,445 participants of average 40-year old and 86% of them were women randomised to 17 individual drugs or placebo.
The trials included in the studies were of different quality however the certainty of the evidence was evaluated by the researchers using a recognised tool.
As presented in the results, all the drugs were more efficacious in relieving pain compared to placebo at two hours and the majority exhibited efficacy for up to 24 hours except paracetamol and naratriptan.
When drugs were compared each with the other, it was observed that eletriptan was the most effective drug for pain relief at two hours post dosing followed by rizatriptan, sumatriptan and zolmitriptan.
In the case of persistent pain for 24 hrs., eletriptan and ibuprofen were the most effective drugs.
The researchers underscore that the top-ranked triptans should be regarded for migraine attacks and included into the WHO Model List of Essential Medicines to improve patients’ access to effective and standardised treatments globally.
They realise that some individuals cannot use triptans because of the risk factors related to heart diseases and other issues such as side effects.
However, they suggest that these results, while restricted to mean treatment effects because of the absence of further patient-level data, are ‘the best current evidence to inform selection of acute oral drug therapies for migraine attacks’ and ‘should be adopted to inform treatment decisions and thus foster shared decision-making between patients and providers.’
Reference:
Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis, The BMJ (2024). DOI: 10.1136/bmj-2024-080107
