Messali Andrew J, Yang Mo, Gillard Patrick, Tsai Kimberly, Tepper Stewart J, Bloudek Lisa M, Kori Shashidhar H
Allergan, Inc., Irvine, CA, USA; University of Southern California, Los Angeles, CA, USA.
Headache. 2014 Jul-Aug;54(7):1120-30. doi: 10.1111/head.12404. Epub 2014 Jun 10.
To conduct a systematic review to evaluate persistence to and switching of triptan therapy for the acute treatment of migraine.
Migraine affects over 12% of adults in Western countries and an estimated 36 million people in the United States. Triptans are an abortive treatment option in patients with moderate to severe migraine. Despite the safety and efficacy of triptans reported in clinical trials, observational studies have consistently demonstrated low persistence to therapy and frequent switching among products over time.
The following databases were researched: Medline, CENTRAL, and EMBASE. Detailed inclusion and exclusion criteria were specified a priori before conducting abstract and full-text screening. Included studies were required to: (1) report triptan use for migraine treatment; (2) report measures of persistence and/or switching patterns; (3) study migraineurs aged 18 years or older; and (4) conduct an observational study. Studies were excluded if they (1) incorporated interventional study design; (2) lack information or relevance to outcome of interest; (3) were not original research; (4) did not clearly state the results; and (5) were not written in English. Abstracts and full-text articles were reviewed independently by two investigators.
Out of 595 studies identified, 380 studies were included for abstract screening. A total of 12 articles met the eligibility criteria after full-text screening of 44 studies, including four studies from reference search. The proportion of patients that remained persistent up to six refills of an index triptan ranged from 3.2% to 12.6% and the proportion of patients that never refilled their index triptan ranged from 38% to 65.8%. In addition to those patients who discontinued, several studies reported that 5-9% of newly initiating triptan users switch to a different triptan before refilling their original medication. Finally, several studies reported the 1-year probability of discontinuation among a general group of triptan users (not limited to treatment naïve patients) to be between 30% and 60%.
Triptans can be a valuable option for acute treatment of migraine. However, studies have shown that treatment persistence is low. This, along with frequent switching behaviors, suggests that a significant unmet clinical need remains despite the wide availability of triptans.
进行一项系统评价，以评估曲坦类药物用于偏头痛急性治疗的持续性及换药情况。
偏头痛影响着西方国家超过12%的成年人，在美国估计有3600万人患病。曲坦类药物是中重度偏头痛患者的一种终止发作治疗选择。尽管临床试验报告了曲坦类药物的安全性和有效性，但观察性研究一直表明随着时间推移，治疗的持续性较低且产品间频繁换药。
检索了以下数据库：Medline、CENTRAL和EMBASE。在进行摘要和全文筛选之前，预先明确了详细的纳入和排除标准。纳入的研究需：（1）报告曲坦类药物用于偏头痛治疗的情况；（2）报告持续性和/或换药模式的测量指标；（3）研究年龄在18岁及以上的偏头痛患者；（4）进行观察性研究。如果研究（1）采用干预性研究设计；（2）缺乏与感兴趣结局相关的信息；（3）不是原创研究；（4）未明确陈述结果；（5）不是用英文撰写，则予以排除。两位研究者独立审查摘要和全文文章。
在识别出的595项研究中，380项研究纳入摘要筛选。在对44项研究进行全文筛选后，共有12篇文章符合纳入标准，包括通过参考文献检索得到的4项研究。在索引曲坦类药物最多续方6次的情况下，持续用药的患者比例为3.2%至12.6%，从未续方索引曲坦类药物的患者比例为38%至65.8%。除了那些停药的患者外，几项研究报告称，5%至9%的新开始使用曲坦类药物的患者在重新填充原药物之前换用了不同的曲坦类药物。最后，几项研究报告了曲坦类药物使用者总体群体（不限于初治患者）中1年停药的概率在30%至60%之间。
曲坦类药物可以是偏头痛急性治疗的一种有价值的选择。然而，研究表明治疗持续性较低。这一点以及频繁的换药行为表明，尽管曲坦类药物广泛可得，但仍存在重大未满足的临床需求。
