Cutrer F Michael, Goadsby Peter J, Ferrari Michel D, Lipton Richard B, Dodick David W, McCrory Douglas, Williams Paul
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Clin Ther. 2004 Sep;26(9):1533-45. doi: 10.1016/j.clinthera.2004.09.011.
Physicians treating patients with migraine can now choose from among 7 triptans, which differ on a range of attributes that may be important for treatment selection.
The aims of this study were to determine the relative importance of treatment attributes of the available triptans and assess their impact on deciding the most appropriate treatment for a particular patient with migraine.
As part of the TRIPSTAR project, US primary care physicians were surveyed to elicit their views on the relative importance of a prespecified set of treatment attributes for making treatment choices in clinical practice. The treatment attributes assessed were those for which data from controlled clinical trials were available for subsequent comparison. The resulting attribute-importance weights were then combined with data on the performance of individual triptans across these attributes in a multiattribute decision model to assist selection of an oral triptan.
Efficacy attributes were considered more important than tolerability or consistency of effect in selecting an oral triptan. For triptan-naive but not triptan-experienced patients, tolerability was considered significantly more important than consistency (30% [95% CI, 27%-34%] vs 21% [19%-24%]). Sustained pain-free status and freedom from cardiovascular (chest) adverse events were the most important efficacy and tolerability attributes for both patient categories. When the relative importance of the treatment attributes was combined in a multiattribute decision model with meta-analysis data from controlled trials, almotriptan, eletriptan, and rizatriptan were significantly closer to the hypothetical ideal triptan than the reference product, sumatriptan 100 mg.
Multiattribute decision-making models (such as that used in the TRIPSTAR project) that determine and apply the relative importance of treatment attributes to drug selection have considerable potential value as a decision support tool in the treatment of acute migraine.
治疗偏头痛患者的医生现在可以从7种曲坦类药物中进行选择，这些药物在一系列可能对治疗选择很重要的属性上存在差异。
本研究的目的是确定现有曲坦类药物治疗属性的相对重要性，并评估其对为特定偏头痛患者选择最合适治疗方法的影响。
作为TRIPSTAR项目的一部分，对美国初级保健医生进行了调查，以了解他们对一组预先指定的治疗属性在临床实践中进行治疗选择时相对重要性的看法。评估的治疗属性是那些有来自对照临床试验的数据可用于后续比较的属性。然后，在多属性决策模型中，将所得的属性重要性权重与各曲坦类药物在这些属性上的表现数据相结合，以辅助选择口服曲坦类药物。
在选择口服曲坦类药物时，疗效属性被认为比耐受性或疗效一致性更重要。对于初用曲坦类药物但非用过曲坦类药物的患者，耐受性被认为比疗效一致性重要得多（30%[95%CI，27%-34%]对21%[19%-24%]）。持续无痛状态和无心血管（胸部）不良事件是两类患者最重要的疗效和耐受性属性。当将治疗属性的相对重要性与来自对照试验的荟萃分析数据结合在多属性决策模型中时，阿莫曲坦、依立曲坦和利扎曲坦比对照产品100mg舒马曲坦显著更接近假设的理想曲坦类药物。
确定并应用治疗属性对药物选择的相对重要性的多属性决策模型（如TRIPSTAR项目中使用的模型）作为急性偏头痛治疗中的决策支持工具具有相当大的潜在价值。
