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Elimination of Migraine-Associated Nausea in Patients Treated with Rizatriptan Orally Disintegrating Tablet (ODT): A Randomized, Double-Blind, Placebo-Controlled Study

Authors

  • Fred Freitag DO,

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Frederick R. Taylor MD,

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Mohammed A. Hamid MD, PhD,

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Anthony Rodgers MS,

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Carolyn M. Hustad PhD,

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Karen E. Ramsey RPh,

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Franck Skobieranda MD

    1. From the Diamond Headache Clinic, Chicago, IL, USA (Dr. Freitag); Park Nicollet Health Services—Headache Clinic and Research Center, Minneapolis, MN, USA (Dr. Taylor); Cleveland Hearing and Balance Center—Beechwood, OH, USA (Dr. Hamid); Merck & Co., Inc., West Point, PA, USA (Drs. Hustad and Skobieranda and Mr. Rodgers and Ms. Ramsey).
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  • Conflict of Interest: None

Dr. Fred Freitag, Diamond Headache Clinic, 467 West Deming Place, Suite 500, Chicago, IL, 60614, USA.

Abstract

Objective.— To confirm the efficacy of rizatriptan 10 mg orally disintegrating tablet (ODT) for the elimination of migraine-associated nausea.

Background.— Pooled studies of rizatriptan analyzing elimination of nausea as a secondary endpoint showed that 65% of rizatriptan patients reported elimination of nausea at 2 hours compared with 41% of patients taking placebo.

Methods.— This was a multicenter, randomized, double-blind, placebo-controlled single-attack trial enrolling adult patients with at least a 6-month history of migraine who typically experience migraine-associated nausea. Patients treated a moderate or severe migraine headache at the earliest sign of nausea with either rizatriptan 10 mg ODT or placebo (2 : 1). The primary endpoint was elimination of nausea at 2 hours postdose, and the secondary endpoint was pain relief at 2 hours postdose.

Results.— Although not statistically significant, a greater percentage of patients had elimination of nausea at 2 hours with rizatriptan compared with placebo (70.3% vs 62.0%, P = .165, odds ratio [95% CI] = 1.45 [0.86, 2.46]). When patients were grouped by baseline headache severity, rizatriptan showed a greater advantage than placebo for patients with moderate pain (rizatriptan 72.8% vs placebo 57.4%), but no difference for patients with severe pain (rizatriptan 67.7% vs placebo 66.7%). There were significantly more patients who achieved 2-hour pain relief with rizatriptan (69.7% vs 54.3%, P = .012, odds ratio [95% CI] = 1.94 [1.16, 3.25]).

Conclusion.— Although the efficacy of rizatriptan 10 mg ODT for the elimination of migraine-associated nausea was comparable to that seen in previous rizatriptan trials, the higher-than-usual placebo response prevented a finding of a statistically significant difference. There was a sizable difference in placebo response between patients who treated moderate vs severe migraine. Rizatriptan was effective for 2-hour pain relief.

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