Effects of Switching Acute Treatment on Disability in Migraine Patients Using Triptans

Authors


  • Conflict of Interest:

    Daniel Serrano, PhD, has received grant support and honoraria from Allergan Pharmaceuticals, Colucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation.

    Dawn C. Buse, PhD, has received grant support and honoraria from Allergan Pharmaceuticals, Endo Pharmaceuticals, Iroko Pharmaceuticals, MAP Pharmaceuticals, Merck & Co., Inc., Novartis, and NuPathe.

    Shashi H. Kori, MD, is a full-time employee of MAP Pharmaceuticals, Mountain View, CA, USA.

    Sypridon Papapetropoulos, MD, PhD was a full-time employee of Allergan Pharmaceuticals, Irvine, CA, USA, at the time of writing this manuscript. He is now a full-time employee of Pfizer, Inc., Cambridge, MA, USA.

    Cedric M. Cunanan, MPH, is a full-time employee of Allergan Pharmaceuticals, Irvine, CA, USA.

    Aubrey N. Manack, PhD, is a full time employee of Allergan Pharmaceuticals, Irvine, CA, USA.

    Michael L. Reed, PhD, has received grant support and honoraria from Allergan Pharmaceuticals, Colucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation.

    Richard B. Lipton, MD, receives research support from the National Institutes of Health (PO1 AG03949 [program director], RO1AG025119 [investigator], RO1AG022374-06A2 [investigator], RO1AG034119 [investigator], RO1AG12101 [investigator], K23AG030857 [mentor], K23NS05140901A1 [mentor], and K23NS47256 [mentor]), the National Headache Foundation, and the Migraine Research Fund; serves on the editorial board of Neurology reviewed for the National Institute on Aging and National Institute of Neurological Disorders and Stroke; holds stock options in eNeura Therapeutics (a company without commercial products); and serves as consultant, advisory board member, or has received honoraria from Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol-Myers Squibb, Cognimed, Colucid, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, MAP Pharmaceuticals, Merck, Nautilus Neuroscience, Novartis, NuPathe, Pfizer, and Vedanta.

  • Funding Statement: The AMPP Study is funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologics, Inc., Titusville, NJ, USA. Additional analyses and manuscript preparation were supported through a grant from MAP Pharmaceuticals, Mountain View, CA, USA, and Allergan Inc., Irvine, CA, USA, to the National Headache Foundation.

Address all correspondence to D. Serrano, Vedanta Research, 906 Emory Drive, Chapel Hill, NC 27517, USA, email:dserrano@vedantaresearch.com

Abstract

Objective

To assess the influence of switching acute treatment on headache-related disability in a population sample of individuals with migraine using acute triptan therapy.

Background

Acute treatments for migraine are often modified in clinical practice. The effect of changes in treatment from one triptan to another or from a triptan to another medication class has rarely been studied.

Methods

Patterns of acute treatment for migraine were monitored from 1 year to the next in the American Migraine Prevalence and Prevention (AMPP) Study for the following couplets (2005-2006, 2006-2007, 2007-2008, and 2008-2009). Changes in medication regimens were classified as follows: (1) switch within the triptan class; (2) switch to combination analgesics containing opioids or barbiturates; (3) switch to non-steroidal anti-inflammatory drug (NSAID) agents; (4) maintaining current therapy (consistent use, “control”). We assessed change in migraine disability assessment scale score from the first to the second year of a couplet contrasting those with consistent use with those who changed acute treatment. Each individual contributed only 1 couplet to the analysis. Persons who added an acute treatment are considered in a separate manuscript. We modeled change in migraine disability assessment scale score as a function of change in medication regimen with consistent users as the control group.

Results

We identified 81 individuals who switched to another triptan, with a referent of 619 who remained consistent, 31 cases who switched to an opioid or barbiturate with a referent of 666 who remained consistent, and 20 cases who switched to an NSAID with a referent of 667 cases who remained consistent. In cell-mean coded analyses of covariance (ANCOVA), switching from one triptan to another or switching from a triptan to an opioid/barbiturate was never associated with significant improvements in headache-related disability compared with consistent treatment. Switching from a triptan to an NSAID was associated with significant increases in headache-related disability among those with high-frequency episodic/chronic migraine (HFEM/CM) compared with those with low-frequency episodic migraine (LFEM) (interaction = 34.81, 95% confidence interval 10.61 to 59.00). The same was true comparing high-frequency episodic/chronic migraine with those with moderate-frequency episodic migraine (interaction = 48.73, 95% confidence interval 2.63 to 94.83).

Conclusions

In this observational study, switching triptan regimens does not appear to be associated with improvements in headache-related disability and in some cases is associated with increased headache-related disability.

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