Funding Source: This study was funded by Merck & Co., Inc.
Migraine Treatment With Rizatriptan and Almotriptan: A Crossover Study
Article first published online: 27 APR 2009
© 2009 the Authors. Journal compilation © 2009 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 49, Issue 5, pages 655–662, May 2009
How to Cite
Ng-Mak, D. S., Hu, X. H. and Bigal, M. (2009), Migraine Treatment With Rizatriptan and Almotriptan: A Crossover Study. Headache: The Journal of Head and Face Pain, 49: 655–662. doi: 10.1111/j.1526-4610.2009.01404.x
Conflict of Interest: All authors of this manuscript are employees of Merck & Co., Inc.
- Issue published online: 27 APR 2009
- Article first published online: 27 APR 2009
- Accepted for publication January 6, 2009.
- acute migraine;
- onset of efficacy
Background.— Rizatriptan and almotriptan are effective and well-tolerated triptans that have not been compared directly.
Objective.— To evaluate the effectiveness of rizatriptan 10 mg and almotriptan for the acute treatment of migraine, in a real-world setting.
Methods.— Of a large, multicenter, open-label, crossover study, we conducted a substudy to contrast the effectiveness of rizatriptan 10 mg and almotriptan 12.5 mg for the acute treatment of 2 migraine attacks in a sequential, crossover manner. Time to outcome was assessed using stopwatches. Mean and median times to onset of pain relief (PR) and pain freedom (PF) for rizatriptan and almotriptan were compared. The effect of rizatriptan on times to onset of PR and PF, adjusting for potential confounding factors (treatment sequence, treatment order, and use of rescue medication), was computed via a Cox proportional hazard model.
Results.— Out of the 146 patients taking almotriptan as their usual care medication, 79 used stopwatch for both attacks. Significantly more patients taking rizatriptan achieved onset of PR within 2 hours after dosing than those taking almotriptan (88.6% vs 73.4%, P = .007). A higher proportion of patients taking rizatriptan achieved PF within 2 hours after dosing than those taking almotriptan (55.7% vs 45.6%, P = .10). Times to onset of PR and PF were significantly shorter with those patients taking rizatriptan than with those taking almotriptan (median time to PR: 45 vs 60 minutes, P = .002; median time to PF: 100 vs 135 minutes, P = .004). The adjusted proportional hazard ratios (rizatriptan vs almotriptan) for times to onset of PR and PF were 1.51 (95% confidence interval 1.20 to 1.88) and 1.42 (95% confidence interval 1.15 to 1.76), respectively. More patients were very satisfied when treating their attacks with rizatriptan than with almotriptan. Rizatriptan was preferred by most patients.
Conclusions.— Times to achieve PR and PF were significantly shorter for patients using rizatriptan, as compared with those using almotriptan.