依立曲坦对非甾体抗炎药持续反应不佳的偏头痛患者的疗效。

Chia Yook-Chin, Lim Shih-Hui, Wang Shuu-Jiun, Cheong Y M, Denaro Jean, Hettiarachchi Jayasena

University Malaya Medical Centre, Kuala Lumpur, Malaysia.

Headache. 2003 Oct;43(9):984-90. doi: 10.1046/j.1526-4610.2003.03190.x.

BACKGROUND/OBJECTIVE: Nonsteroidal anti-inflammatory drugs continue to be one of the most widely used therapies for migraine, but their efficacy in treating moderate to severe migraine headache has not been well documented. In contrast, the efficacy of triptans in this group of patients is well documented, although no systematic research is available that evaluates the effectiveness of switching to a triptan in patients who respond poorly to nonsteroidal anti-inflammatory drugs.

METHODS

One hundred thirteen patients who met International Headache Society criteria for migraine and who did not experience satisfactory response to nonsteroidal anti-inflammatory drugs, received open-label treatment with a 40-mg dose of eletriptan for one migraine attack. Efficacy assessments were made at 1, 2, 4, and 24 hours postdose and consisted of headache and pain-free response rates, absence of associated symptoms, and functional response. Global ratings of treatment effectiveness and preference were obtained at 24 hours.

RESULTS

The pain-free response rate at 2 hours postdose was 25% and at 4 hours postdose, 55%; the headache response rate at 2 hours was 66% and at 4 hours, 87%. At 2 hours postdose, relief of baseline associated symptoms was achieved by 41% of patients with nausea compared to 82% of patients at 4 hours; for patients with phonophobia, 67% were relieved at 2 hours and 93% at 4 hours, and for patients with photophobia, 70% were relieved at 2 hours and 91% at 4 hours. Functional response was achieved by 70% of patients by 2 hours postdose. The high level of acute response was maintained over 24 hours, with only 24% of patients experiencing a headache recurrence and only 10% using rescue medication. At 24 hours postdose, 74% of patients rated eletriptan as preferable to any previous treatment for migraine. The most frequent reasons cited for this treatment preference were faster headache improvement (83%) and functional response (78%). Overall, eletriptan was well tolerated; most adverse events were transient and mild to moderate in severity. No serious adverse events were reported.

CONCLUSION

Results of this open-label trial found the 40-mg dose of eletriptan to have a high degree of efficacy and tolerability among patients who responded poorly to nonsteroidal anti-inflammatory drugs.

背景/目的：非甾体类抗炎药仍然是治疗偏头痛最广泛使用的疗法之一，但其治疗中度至重度偏头痛的疗效尚未得到充分证实。相比之下，曲坦类药物在这类患者中的疗效已有充分记录，尽管尚无系统研究评估对非甾体类抗炎药反应不佳的患者改用曲坦类药物的有效性。

方法

113名符合国际头痛协会偏头痛标准且对非甾体类抗炎药未产生满意反应的患者，接受了40毫克依立曲坦的开放标签治疗，用于一次偏头痛发作。在给药后1、2、4和24小时进行疗效评估，包括头痛和无痛反应率、无相关症状以及功能反应。在24小时时获得对治疗效果和偏好的总体评分。

结果

给药后2小时无痛反应率为25%，4小时时为55%；2小时时头痛反应率为66%，4小时时为87%。给药后2小时，41%有恶心症状的患者基线相关症状得到缓解，4小时时这一比例为82%；有恐声症的患者，2小时时67%症状得到缓解，4小时时为93%；有畏光症的患者，2小时时70%症状得到缓解，4小时时为91%。给药后2小时，70%的患者实现了功能反应。高水平的急性反应在24小时内得以维持，只有24%的患者头痛复发，只有10%的患者使用了急救药物。给药后24小时，74%的患者将依立曲坦评为比之前任何偏头痛治疗方法都更优。这种治疗偏好最常提及的原因是头痛改善更快（83%）和功能反应（78%）。总体而言，依立曲坦耐受性良好；大多数不良事件是短暂的，严重程度为轻度至中度。未报告严重不良事件。