Kozma C M, Mauch R P, Reeder C E, Lawrence B J
University of South Carolina, College of Pharmacy, Columbia 29208.
Clin Ther. 1994 Nov-Dec;16(6):1037-51; discussion 1036.
The value of different pharmaceuticals in treating migraine is frequently based on clinical efficacy only. This article assumes a broader perspective and compares the clinical, economic, and humanistic attributes of two antimigraine medications, dihydroergotamine (DHE) and sumatriptan, based on a literature review. DHE is an established product with over 40 years of use in the treatment of migraine. Sumatriptan is a new product with a higher acquisition cost than DHE. Because sumatriptan costs more than DHE, the question must be asked. "Does sumatriptan provide advantages that offset this price differential?" This question reflects the growing concern among payers and patients over the cost and effectiveness of therapies. However, it is not easily answered. Direct comparative data are not available, and data sources are different for the two products. Moreover, the products are currently marketed in different dosage forms--intramuscular for DHE and subcutaneous for sumatriptan. The literature reviewed indicates that the clinical attributes of the two products are similar, with each having slightly different advantages and disadvantages. However, the DHE literature is generally limited to uncontrolled studies, whereas the sumatriptan literature reports the results of rigorously designed, randomized, double-blind, placebo-controlled clinical trials. Published data on the products' economic and humanistic attributes are limited. We concluded that the literature does provide important, albeit limited, data on the economic, clinical, and humanistic attributes of DHE and sumatriptan that permit restricted comparisons. The limitations of the data highlight the need for comparative studies of these products' multidimensional attributes both in controlled clinical trials and under actual practice conditions.
不同药物治疗偏头痛的价值通常仅基于临床疗效。本文从更广泛的角度出发，通过文献综述比较了两种抗偏头痛药物二氢麦角胺（DHE）和舒马曲坦的临床、经济和人文属性。DHE是一种已使用40多年的成熟产品，用于治疗偏头痛。舒马曲坦是一种新产品，采购成本高于DHE。由于舒马曲坦的成本高于DHE，因此必然会产生这样一个问题：“舒马曲坦是否具有能够抵消这种价格差异的优势？” 这个问题反映了付款人和患者对治疗成本和效果的日益关注。然而，这个问题并不容易回答。没有直接的对比数据，而且这两种产品的数据来源也不同。此外，这两种产品目前的剂型不同 —— DHE为肌肉注射剂，舒马曲坦为皮下注射剂。所综述的文献表明，这两种产品的临床属性相似，各有略有不同的优缺点。然而，关于DHE的文献通常仅限于非对照研究，而关于舒马曲坦的文献则报告了严格设计的随机双盲安慰剂对照临床试验的结果。关于这两种产品经济和人文属性的已发表数据有限。我们得出的结论是，文献确实提供了关于DHE和舒马曲坦经济、临床和人文属性的重要数据，尽管有限，但足以进行有限的比较。数据的局限性凸显了在对照临床试验和实际临床条件下对这些产品多维属性进行比较研究的必要性。
