Rizatriptan for Treatment of Acute Migraine in Patients Taking Topiramate for Migraine Prophylaxis

Authors

  • Jeffrey L. Seeburger PhD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Roger K. Cady MD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Paul Winner DO,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Anne MacGregor MD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Dominique Valade MD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Yang Ge PhD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Ying Zhang PhD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Carolyn M. Hustad PhD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Nancy Strickler BS,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Eleanor Schaefer BS,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Kathryn M. Connor MD,

    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
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  • Tony W. Ho MD

    Corresponding author
    1. From Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA (J.L. Seeburger, Y. Ge, Y. Zhang, C.M. Hustad, N. Strickler, E. Schaefer, K.M. Connor, and T.W. Ho); Banyan Group Inc., Springfield, MO, USA (R.K. Cady); Palm Beach Headache Center, West Palm Beach, FL, USA (P. Winner); Barts and the London School of Medicine and Dentistry, London, England, UK (A. MacGregor); Centre d'Urgences Céphalées, Hôpital Lariboisière, Paris, France (D. Valade)
      T.W. Ho, Merck Sharp & Dohme Corp., 351 Sumneytown Pike, UG4C-06, North Wales, PA 19454, USA, email: tony.ho@merck.com
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  • Finance Support: This study was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

  • Conflict of Interest: Drs. Cady, Winner, MacGregor, and Valade have received research grants and honoraria from Merck. Drs. Seeburger, Hustad, Ho, Ge, Zhang, and Connor and Ms. Strickler are employed by Merck and may own stock in the company. Ms. Schaefer was an employee of Merck at the time of the study.

T.W. Ho, Merck Sharp & Dohme Corp., 351 Sumneytown Pike, UG4C-06, North Wales, PA 19454, USA, email: tony.ho@merck.com

Abstract

Objective.— To assess efficacy and tolerability of rizatriptan orally disintegrating tablet (ODT) for treatment of acute migraine in patients using topiramate for migraine prophylaxis.

Background.— There are limited data from prospective controlled trials demonstrating the benefit of triptans in patients who experience migraine attacks while taking prophylactic medication.

Methods.— This was a worldwide, randomized, placebo-controlled, double-blind, multiple-attack study in adults with a >1-year history of migraine taking a stable dose of topiramate for migraine prophylaxis and experiencing ≥2 moderate/severe attacks per month. Participants treated 3 moderate/severe attacks in crossover fashion (2 with rizatriptan 10-mg ODT, 1 with placebo) following random assignment to 1 of 3 treatment sequences. The primary end point was 2-hour pain relief.

Results.— Two-hour pain relief was significantly greater with rizatriptan compared with placebo (55.0% vs 17.4%, P < .001). Response rates also favored rizatriptan for sustained pain relief from 2-24 hours (32.6% vs 11.1%, P < .001), 2-hour pain freedom (36.0% vs 6.5%, P < .001), normal functional ability at 2 hours (42.2% vs 12.7%, P < .001), and overall treatment satisfaction at 24 hours (60.8% vs 33.6%, P < .001). Few participants reported adverse experiences (16 [15.8%] with rizatriptan, 3 [3.2%] with placebo); none were serious.

Conclusion.— Rizatriptan 10-mg ODT was superior to placebo at all pain end points for treatment of acute migraine in patients using topiramate for migraine prophylaxis. Rizatriptan was generally well tolerated in this population. These results are comparable with those from clinical trials in patients not using prophylaxis, suggesting that the use of topiramate does not affect the efficacy or tolerability of rizatriptan for acute migraine treatment.

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