Mercy Health Research, St. Louis, MO 63141, USA.
Curr Med Res Opin. 2012 Jul;28(7):1231-8. doi: 10.1185/03007995.2012.674501. Epub 2012 Jun 26.
The features of migraine attacks and the contexts in which migraine attacks occur vary from attack to attack and from patient to patient. Current treatment strategies, which are dominated by the use of oral forms of migraine medication, do not address this patient-to-patient and attack-to-attack heterogeneity. While current therapies, and, in particular, oral triptan tablets can be effective for many types of migraine attacks that a patient can experience, they may not be the optimum treatment for every migraine in every patient.
This clinical review of subcutaneous sumatriptan discusses its characteristics, efficacy, and tolerability and considers its place in clinical practice. The review focuses particularly on several specific clinical settings in which subcutaneous sumatriptan might be a more appropriate therapeutic choice than the oral triptan tablet.
Of the triptan formulations, subcutaneous sumatriptan is the most rapidly absorbed and demonstrates a favorable pharmacokinetic profile. Data from randomized, double-blind, clinical trials and studies of patients' perceptions and preferences suggest that subcutaneous sumatriptan can be particularly useful to help restore normal work functioning, for migraine attacks that cannot be treated early in their course, for migraine attacks associated with gastrointestinal symptoms, such as nausea or vomiting, and for difficult-to-treat migraines, including early-morning migraine and menstrual migraine. The majority of patients (9 in 10) trying subcutaneous sumatriptan indicated that they will use it again. Patients not fully satisfied with previous triptan therapy reported enhanced satisfaction with, and confidence in, treatment after trying subcutaneous sumatriptan.
By virtue of their availability as multiple compounds and in multiple formulations including oral, intranasal, and injectable forms, triptans can be used to customize migraine therapy to the individual patient and the individual migraine attack. Due to its route of delivery and favorable pharmacokinetic profile, subcutaneous triptans may represent an attractive alternative for specific clinical settings. Subcutaneous sumatriptan can play a key role in maximizing likelihood of pain-free response and rapid return to normal daily activities and, as such, should be considered an important part of the treatment armamentarium for migraine.
偏头痛发作的特征以及偏头痛发作发生的情况在每次发作和每个患者之间都有所不同。目前的治疗策略主要以口服形式的偏头痛药物为主，无法解决这种患者间和发作间的异质性。虽然目前的治疗方法，特别是口服曲坦类片剂，对许多患者可能经历的偏头痛发作类型可能有效，但它们可能不是每个患者的每个偏头痛的最佳治疗方法。
本文对皮下注射舒马曲坦进行了临床综述，讨论了其特点、疗效和耐受性，并考虑了其在临床实践中的地位。该综述特别关注了皮下注射舒马曲坦可能比口服曲坦片剂更适合治疗的几种特定临床情况。
在曲坦类药物中，皮下注射舒马曲坦吸收最快，表现出良好的药代动力学特征。来自随机、双盲临床试验和患者感知和偏好研究的数据表明，皮下注射舒马曲坦对于以下情况特别有用：帮助恢复正常工作功能，对于不能在发作早期治疗的偏头痛发作，对于伴有胃肠道症状（如恶心或呕吐）的偏头痛发作，以及对于难以治疗的偏头痛，包括清晨偏头痛和经期偏头痛。尝试皮下注射舒马曲坦的大多数患者（9 人中的 10 人）表示他们将再次使用它。与之前使用曲坦类药物治疗效果不佳的患者相比，尝试皮下注射舒马曲坦的患者表示对治疗的满意度更高，信心更强。
由于曲坦类药物以多种化合物和多种制剂（包括口服、鼻内和注射形式）提供，因此可以根据个体患者和个体偏头痛发作来定制偏头痛治疗方案。由于其给药途径和良好的药代动力学特征，皮下曲坦类药物可能代表特定临床情况的一种有吸引力的替代选择。皮下舒马曲坦可以在最大程度地提高无疼痛反应的可能性和快速恢复正常日常活动方面发挥关键作用，因此应被视为偏头痛治疗的重要组成部分。
