Perry C M, Markham A
Adis International Limited, Auckland, New Zealand.
Drugs. 1998 Jun;55(6):889-922. doi: 10.2165/00003495-199855060-00020.
Sumatriptan is a selective agonist at serotonin 5-HT1-like receptors, including 5-HT1B/1D subtypes. It is an effective treatment for acute migraine attacks and the injectable form has also shown efficacy in the treatment of cluster headaches. In placebo-controlled clinical trials, sumatriptan, administered subcutaneously, orally, intranasally or rectally was significantly more effective than placebo in relieving migraine headache and in producing resolution or reduction of other symptoms associated with migraine, including nausea, photophobia and phonophobia. Improvements in clinical disability were also significantly greater after sumatriptan than after placebo. Headache recurred in 21 to 57% of patients who received oral or subcutaneous sumatriptan, but most patients responded to a second dose of the drug. Results of comparative trials showed that subcutaneous sumatriptan 6 mg was significantly more effective than either patients' usual antimigraine treatments or intranasal dihydroergotamine mesylate 1 mg in relieving migraine headache. Subcutaneous sumatriptan 6 mg and subcutaneous dihydroergotamine mesylate 1 mg provided similarly effective migraine relief, but the headache recurrence rate was significantly higher after sumatriptan than after this formulation of dihydroergotamine mesylate. Response rates achieved after oral sumatriptan were similar to those reported after treatment with oral naratriptan, rizatriptan or lysine acetylsalicylate plus metoclopramide. Treatment of acute migraine attacks with oral or subcutaneous sumatriptan leads to less loss of workplace productivity than other antimigraine therapies. Several pharmacoeconomic analyses showed that gains in workplace productivity in sumatriptan recipients ranged from 12.1 to 89.8 hours per patient per year. Significant improvements from baseline in overall health-related quality-of-life scores were also experienced by sumatriptan recipients. Sumatriptan is generally well tolerated. Nausea, vomiting, malaise and fatigue are the most common adverse events with oral sumatriptan. Injection site reactions occur in 10 to 40% of patients receiving the drug subcutaneously. A bitter taste at the back of the mouth occurs frequently after intranasal administration. Serious adverse events occur in about 0.14% of patients with migraine treated with sumatriptan. As the drug is associated with the rare development of cardiovascular effects, it is contraindicated in patients with a history of cardiovascular disease.
Despite its relatively high acquisition cost, reductions in lost workplace productivity experienced by patients treated with sumatriptan may result in savings in the overall cost of migraine to society. Thus, sumatriptan is a useful first- or second-line treatment option for patients with moderate or severe migraine.
舒马曲坦是5-羟色胺5-HT1样受体（包括5-HT1B/1D亚型）的选择性激动剂。它是急性偏头痛发作的有效治疗药物，其注射剂型在丛集性头痛的治疗中也显示出疗效。在安慰剂对照的临床试验中，皮下、口服、鼻内或直肠给药的舒马曲坦在缓解偏头痛以及使与偏头痛相关的其他症状（包括恶心、畏光和畏声）消退或减轻方面显著优于安慰剂。舒马曲坦治疗后临床残疾的改善也显著大于安慰剂。接受口服或皮下舒马曲坦治疗的患者中，21%至57%会出现头痛复发，但大多数患者对第二剂药物有反应。对比试验结果显示，6毫克皮下注射舒马曲坦在缓解偏头痛方面显著优于患者常用的抗偏头痛治疗药物或1毫克鼻内二氢麦角胺甲磺酸盐。6毫克皮下注射舒马曲坦和1毫克皮下注射二氢麦角胺甲磺酸盐在缓解偏头痛方面效果相似，但舒马曲坦治疗后的头痛复发率显著高于这种剂型的二氢麦角胺甲磺酸盐。口服舒马曲坦后的有效率与口服那拉曲坦 [1]、利扎曲坦或赖氨酸乙酰水杨酸加甲氧氯普胺治疗后的报告有效率相似。与其他抗偏头痛疗法相比，口服或皮下注射舒马曲坦治疗急性偏头痛发作导致的工作场所生产力损失更少。多项药物经济学分析表明，接受舒马曲坦治疗的患者每年工作场所生产力的提高幅度为每位患者12.1至89.8小时。舒马曲坦治疗的患者在总体健康相关生活质量评分方面也相对于基线有显著改善。舒马曲坦一般耐受性良好。恶心、呕吐、不适和疲劳是口服舒马曲坦最常见的不良事件。10%至40%接受皮下注射该药的患者会出现注射部位反应。鼻内给药后口腔后部经常出现苦味。在接受舒马曲坦治疗的偏头痛患者中，约0.14%会发生严重不良事件。由于该药物与罕见的心血管效应有关，有心血管疾病史的患者禁用。
尽管舒马曲坦的购置成本相对较高，但接受其治疗的患者工作场所生产力损失的减少可能会节省偏头痛对社会造成的总体成本。因此，舒马曲坦是中度或重度偏头痛患者有用的一线或二线治疗选择。
