Headache and Drug Abuse Inter-Dep Research Centre,Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia, Italy.
Cephalalgia. 2010 Jul;30(7):847-54. doi: 10.1177/0333102409357956. Epub 2010 Mar 17.
The aims of this survey were: (i) to examine the pharmacoepidemiology of triptans in a headache centre; (ii) to compare the characteristics of patients who continued to take triptans with those of patients who had discontinued them.
We enrolled all migraine patients according to ICHD-II criteria, ensuring they were over 18 years of age, consecutively examined during a follow-up visit at the Headache Centre of the University Hospital of Modena from October 2008 to March 2009. Only patients who had used or were using a triptan were included. A specific questionnaire about the use and tolerability of triptans was created for the study and administered to every patient.
On the whole, 343 patients (migraine without aura: 72%; chronic migraine: 26%; migraine with aura: 2%; mean age 40.4 +/- 10 years) had used or were using triptans. Most patients (72%) continued to use triptans, above all for their efficacy. The minority (28%) discontinuing them were younger and suffered from less severe migraine; 59% of them had discontinued triptans because of adverse effects. Indeed, 92% of these patients versus 57% of patients who were currently using triptans reported adverse effects (p < .0001, Fisher's exact test). The number of patients reporting adverse effects significantly decreased with age (r = -0.230, p < .005, simple linear regression analysis). The triptan discontinued by the highest percentage of patients (84%) was subcutaneous 6 mg sumatriptan. Significantly more patients reported adverse effects with subcutaneous 6 mg (89%) and tablet 100 mg sumatriptan (67%) than with any other triptan.
The increase of the tolerability of triptans with age could partly explain why younger patients suffering from less severe migraine tend to discontinue triptans more than older patients suffering from more severe migraine. In the latter, the efficacy and better tolerability (but not necessarily safety) of triptans could foster the overuse of these medications.
本研究旨在：（i）调查头痛中心中曲坦类药物的应用情况；（ii）比较继续使用曲坦类药物和停止使用曲坦类药物的患者的特征。
根据 ICHD-II 标准，我们连续招募了 2008 年 10 月至 2009 年 3 月期间在摩德纳大学医院头痛中心就诊的所有偏头痛患者，入组标准为年龄>18 岁。仅纳入使用或正在使用曲坦类药物的患者。为该研究创建了一个关于曲坦类药物使用和耐受性的专门问卷，并分发给每位患者。
总体而言，343 名患者（无先兆偏头痛：72%；慢性偏头痛：26%；有先兆偏头痛：2%；平均年龄 40.4±10 岁）使用或正在使用曲坦类药物。大多数患者（72%）继续使用曲坦类药物，主要是因为其疗效。少数（28%）停药患者年龄较小，偏头痛症状较轻；其中 59%因不良反应而停药。实际上，与正在使用曲坦类药物的患者（57%）相比，这些患者（92%）报告了不良反应（p<0.0001，Fisher 确切检验）。报告不良反应的患者人数随年龄增加而显著减少（r=-0.230，p<0.05，简单线性回归分析）。最易被患者停用的曲坦类药物（84%）为皮下注射 6mg 舒马曲坦。与其他曲坦类药物相比，皮下注射 6mg 舒马曲坦（89%）和 100mg 片剂舒马曲坦（67%）报告不良反应的患者更多。
曲坦类药物耐受性随年龄增加而提高，这在一定程度上解释了为何年龄较小、偏头痛症状较轻的患者比年龄较大、偏头痛症状较重的患者更倾向于停止使用曲坦类药物。在后者中，曲坦类药物的疗效和更好的耐受性（但不一定是安全性）可能导致这些药物的过度使用。
