Rizatriptan for treatment of acute migraine in patients taking topiramate for migraine prophylaxis.

Abstract

OBJECTIVE:

To assess efficacy and tolerability of rizatriptan orally disintegrating tablet (ODT) for treatment of acute migraine in patients using topiramate for migraine prophylaxis.

BACKGROUND:

There are limited data from prospective controlled trials demonstrating the benefit of triptans in patients who experience migraine attacks while taking prophylactic medication.

METHODS:

This was a worldwide, randomized, placebo-controlled, double-blind, multiple-attack study in adults with a >1-year history of migraine taking a stable dose of topiramate for migraine prophylaxis and experiencing ≥2 moderate/severe attacks per month. Participants treated 3 moderate/severe attacks in crossover fashion (2 with rizatriptan 10-mg ODT, 1 with placebo) following random assignment to 1 of 3 treatment sequences. The primary end point was 2-hour pain relief.

RESULTS:

Two-hour pain relief was significantly greater with rizatriptan compared with placebo (55.0% vs 17.4%, P < .001). Response rates also favored rizatriptan for sustained pain relief from 2-24 hours (32.6% vs 11.1%, P < .001), 2-hour pain freedom (36.0% vs 6.5%, P < .001), normal functional ability at 2 hours (42.2% vs 12.7%, P < .001), and overall treatment satisfaction at 24 hours (60.8% vs 33.6%, P < .001). Few participants reported adverse experiences (16 [15.8%] with rizatriptan, 3 [3.2%] with placebo); none were serious.

CONCLUSION:

Rizatriptan 10-mg ODT was superior to placebo at all pain end points for treatment of acute migraine in patients using topiramate for migraine prophylaxis. Rizatriptan was generally well tolerated in this population. These results are comparable with those from clinical trials in patients not using prophylaxis, suggesting that the use of topiramate does not affect the efficacy or tolerability of rizatriptan for acute migraine treatment.

• Authors: Jeffrey L Seeburger, Roger K Cady, Paul Winner, Anne MacGregor, Dominique Valade, Yang Ge, Ying Zhang, Carolyn M Hustad, Nancy Strickler, Eleanor Schaefer, Kathryn M Connor, Tony W Ho
• Journal: Headache (Headache) Vol. 52 Issue 1 Pg. 57-67 (Jan 2012) ISSN: 1526-4610 [Electronic] United States
• PMID: 22078129 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 American Headache Society.

Chemical References

• Neuroprotective Agents
• Serotonin Receptor Agonists
• Triazoles
• Tryptamines
• Topiramate
• Fructose
• rizatriptan

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Disability Evaluation
• Double-Blind Method
• Female
• Fructose (analogs & derivatives, therapeutic use)
• Humans
• Male
• Middle Aged
• Migraine Disorders (drug therapy, prevention & control)
• Neuroprotective Agents (therapeutic use)
• Pain Measurement
• Prospective Studies
• Serotonin Receptor Agonists (therapeutic use)
• Severity of Illness Index
• Time Factors
• Topiramate
• Treatment Outcome
• Triazoles (therapeutic use)
• Tryptamines (therapeutic use)
• Young Adult