Seven
triptans are now available for the acute treatment of
migraine. While all of these agents have been shown to be safe and more or less well tolerated, they differ in ways that are clinically relevant to individual patients.
Almotriptan has been investigated in approximately 3,500 patients enrolled in short-term clinical trials and 1,500 patients enrolled in long-term open-label trials. In a meta-analysis of placebo-controlled
almotriptan trials (n = 2,294), treatment with
almotriptan 12.5 mg results in a 2-hour
pain-relief rate of 63.7% and a 2-hour
pain-free rate of 36.4%.
Almotriptan is associated with a rapid onset of action, with 30-min
pain-relief and
pain-free rates significantly better than placebo (p < 0.05). Direct comparator studies show the efficacy of
almotriptan 12.5 mg to be comparable to that of
sumatriptan but
almotriptan is associated with superior tolerability. Trials assessing the efficacy of
almotriptan over multiple attacks show that this agent is associated with a consistent and persistent response, not differing from the first to the last attack, an important property for a medication used to treat a
chronic condition such as
migraine. Early intervention with
almotriptan enhances the activity of this agent. Treatment of mild
pain with
almotriptan has resulted in 2-hour
pain-free rates of 84 and 77% and a sustained
pain-free rate of 67%. Early treatment (within 1 h) of moderate to severe
headaches with
almotriptan also improves outcomes. In conclusion, clinical trials and post hoc analyses of such trials have shown
almotriptan to be effective and well tolerated for the acute treatment of
migraine. Its placebo-like tolerability makes it a good choice for early intervention, a strategy associated with better patient outcomes.