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Rizatriptan 10-mg Wafer Versus Usual Nontriptan Therapy for Migraine: Analysis of Return to Function and Patient Preference

Authors

  • Julio Pascual MD, PhD,

  • Carlos García-Moncó MD, PhD,

  • Carles Roig MD, PhD,

  • Antonio Yusta Izquierdo MD, PhD,

  • Arturo López-Gil MD, PhD,

  • on behalf of the eMAX Study Group


  • From the Neurology Service, University Hospital “Marqués de Valdecilla” (UC), Santander, Spain (Dr. Pascual); Neurology Service, Hospital de Galdakao, Vizcaya, Spain (Dr. García-Moncó); Neurology Service, Hospital Sant Pau, Barcelona, Spain (Dr. Roig); Neurology Service, Hospital Clínico Universitario de Guadalajara, Guadalajara, Spain (Dr. Izquierdo); and Medical Department, MSD Spain, Madrid, Spain (Dr. López-Gil).

Address all correspondence to Dr. Arturo López-Gil, Medical Department, Merck, Sharp & Dohme (MSD), c/ Josefa Valcarcel 38, 28027 Madrid, Spain.

Abstract

Background.—More than half of patients with migraine suffer moderate to severe functional disability during migraine attacks.

Objective.—To compare effects on functional disability at 2 hours after treating a migraine with rizatriptan 10-mg wafer versus usual nontriptan therapy for triptan-naïve patients with migraine.

Design.—Open-label, prospective, two-attack study conducted at 111 neurology clinics.

Methods.—Adult patients with migraine treated two migraine attacks, the first with their usual nontriptan therapy (nonsteroidal anti-inflammatory drugs, 57%; analgesics, 27%; or ergot derivatives, 16%) and the second with rizatriptan 10-mg wafer. Patients recorded pain intensity and functional disability at the start, and functional disability at 2 hours, as well as the time of return to normal function.

Results.—A total of 1353 patients, 76% of them female, completed the study and were considered evaluable. During first and second migraine attacks, 55% and 63% of patients, respectively, reported severe disability or requiring bed rest. At 2 hours after treatment, the likelihood of experiencing any disability was more than five times greater after usual nontriptan therapy than after rizatriptan (odds ratio, 5.68; 95% confidence interval (CI), 4.66 to 6.94; P < .001). Rizatriptan was twice as likely to return patients to normal function than usual nontriptan therapy after adjusting for confounding factors (adjusted hazard ratio, 2.08; 95% CI, 1.92 to 2.25; P < .001). Assessed over all time points up to 6 hours, the speed of return to normal function was 52% faster after rizatriptan therapy (P < .001). Significantly more patients preferred rizatriptan than usual nontriptan therapy (78.8% vs. 21.2%; P < .001). The most common reasons cited for preference for rizatriptan were faster relief of headache pain and faster return to normal function.

Conclusions.—Patients in this study were more likely to experience a return to normal function at 2 hours after receiving rizatriptan than after their usual nontriptan therapy for migraine. The results of this study, using patient-oriented, clinically relevant endpoints such as functional disability and preference, will help to guide practitioners in making recommendations for acute migraine treatment.

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