Evers Stefan, Savi Lidia, Omboni Stefano, Lisotto Carlo, Zanchin Giorgio, Pinessi Lorenzo
Department of Neurology, University of Münster, Münster, Germany,
J Headache Pain. 2015;16:514. doi: 10.1186/s10194-015-0514-8. Epub 2015 Apr 1.
The treatment of migraine attacks with aura by triptans is difficult since triptans most probably are not efficacious when taken during the aura phase. Moreover, there are insufficient data from randomised studies whether triptans are efficacious in migraine attacks with aura when taken during the headache phase. In this metaanalysis, we aimed to compare the efficacy of frovatriptan versus rizatriptan, zolmitriptan, and almotriptan.
Five double-blind, randomized, controlled crossover trials were pooled. All trials had an identical design. Patients were asked to treat three consecutive migraine attacks with frovatriptan 2.5 mg and three consecutive migraine attacks with a comparative triptan (rizatriptan 10 mg; zomitriptan 2.5 mg; almotriptan 12.5 mg).
In this analysis, 117 migraine attacks with aura could be included (intention-to-treat population). The mean headache intensity after 2 hours was 1.2 +/- 1.0 for frovatriptan and 1.6 +/- 1.0 for the other triptans (p<0.05); all triptans showed significant improvement of headache. Frovatriptan resulted in significantly lower relapse rates at 24 hours and 48 hours when taken in migraine attacks with aura.
Our data suggest that frovatriptan is efficacious and even superior in some endpoints also when taken during the headache phase in migraine attacks with aura. This is of particular importance for those many patients who have migraine attacks both without and with aura.
使用曲坦类药物治疗伴有先兆的偏头痛发作存在困难，因为在先兆期服用时，曲坦类药物很可能无效。此外，关于曲坦类药物在头痛期服用时对伴有先兆的偏头痛发作是否有效的随机研究数据不足。在这项荟萃分析中，我们旨在比较夫罗曲普坦与利扎曲普坦、佐米曲普坦和阿莫曲普坦的疗效。
汇总了五项双盲、随机、对照交叉试验。所有试验设计相同。要求患者用2.5毫克夫罗曲普坦治疗连续三次偏头痛发作，并用一种对照曲坦类药物（10毫克利扎曲普坦；2.5毫克佐米曲普坦；12.5毫克阿莫曲普坦）治疗连续三次偏头痛发作。
在该分析中，可纳入117例伴有先兆的偏头痛发作（意向性治疗人群）。夫罗曲普坦组2小时后的平均头痛强度为1.2±1.0，其他曲坦类药物组为1.6±1.0（p<0.05）；所有曲坦类药物均显示头痛有显著改善。在伴有先兆的偏头痛发作中服用时，夫罗曲普坦在24小时和48小时的复发率显著更低。
我们的数据表明，在伴有先兆的偏头痛发作的头痛期服用时，夫罗曲普坦也是有效的，甚至在某些终点上更具优势。这对许多既有无先兆偏头痛发作又有伴有先兆偏头痛发作的患者尤为重要。
