Distúrbios cerebrais e terapia

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Efficacy of Frovatriptan vs. Other Triptans in Weekend Migraine: Pooled Analysis of Three Double-Blind, Randomized, Crossover, Multicenter Studies

Carlo Lisotto, Lidia Savi, Lorenzo Pinessi, Mario Guidotti, Stefano Omboni and Giorgio Zanchin

Background: Migraine attacks usually occur at any time, in particular either during days off or workdays. Limited evidence is available on the efficacy of antimigraine drugs in patients whose attacks occur on weekends.

Objective: To evaluate the efficacy of four different triptans in weekend vs. workday migraine attacks through a pooled analysis of individual data of three randomized, double-blind, crossover studies.

Methods: Subjects with a history of migraine with or without aura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). Each patient was requested to treat up to 3 attacks with each drug during both 3 month periods, as established by the crossover trial protocol. In this retrospective analysis the migraine attacks occurring on workdays were differentiated from those occurring on weekends. The efficacy of the drugs during weekends and workdays was compared.

Results: Of the 346 intention-to-treat population patients, 188 (54%) had migraine attacks also on weekends. Overall, a total of 569 attacks occurred during weekends and 1,281 during workdays. Proportion of pain-free at 2 hours did not significantly differ between weekend and workday attacks for frovatriptan (26% vs. 27%) as well as for comparators (34% vs. 32%). Headache relief episodes were also similarly represented between weekend and nonweekend attacks (frovatriptan: 40% vs. 42% and comparators: 49% vs. 43%, p=NS). Conversely, the relapse rate within 48 hours for weekend attacks compared to workday attacks was significantly lower with frovatriptan (17% vs. 30%, p<0.05), while this finding was not observed for comparators (weekends 34% vs. workdays 40%, p=NS).

Conclusions: Our study provides the first evidence that frovatriptan represents a particularly favorable option for treating weekend migraine attacks.