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Oral eletriptan for acute migraine

Clinical bottom line:

Oral eletriptan 80 mg has been tested in six randomised trials with about 2000 patients. The NNT for two hour headache response was 2.6 (2.4 to 3.0). The NNT for two hour pain free was 3.7 (3.4 to 4.2). The NNT for sustained response was 2.8 (2.5 to 3.2).

Oral eletriptan 40 mg has been tested in six randomised trials with about 2000 patients. The NNT for two hour headache response was 2.9 (2.6 to 3.3). The NNT for two hour pain free was 4.5 (3.9 to 5.1). The NNT for sustained response was 3.6 (3.1 to 4.2).

Oral eletriptan 20 mg has been tested in two randomised trials with about 2000 patients. The NNT for two hour headache response was 4.4 (3.4 to 6.2). The NNT for two hour pain free was 9.9 (6.9 to 17). The NNT for sustained response was 5.4 (3.5 to 12).


References

Smith LA, Oldman AD, McQuay HJ, Moore RA. Eletriptan for acute migraine (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software

AD Oldman, LA Smith, HJ McQuay, RA Moore. A systematic review of treatments for acute migraine. Pain 2002 97: 247-257.

Inclusion criteria were: treatment of acute migraine; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.

Search

Comprehensive searches of the following databases were made: MEDLINE (1966 - July 2000), EMBASE (1980 - June 2000), Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (1950 - 1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Pfizer Inc provided data from seven unpublished trials, one of which has subsequently been published.

Findings

Tables with all included trials and excluded trials are available.

Oral eletriptan 80 mg

The results for the six trials for oral eletriptan 80 mg were consistent for all outcomes, and those for two hour headache response are shown in Figure 1.

Figure 1: Headache response at two hours for oral eletriptan 80 mg

Table 1: Results for oral eletriptan 80 mg

Number/total with outcome (%)

Outcome

Number of trials

Treatment

Placebo

NNT
(95%CI)

Two hour headache response

6

763/1221
(62)

191/779
(25)

2.6 (2.4 to 3.0)

Two hour pain free

6

386/1221
(32)

38/779
(5)

3.7 (3.4 to 4.2)

Headache response at 2 hours sustained to 24 hours

5

618/1160
(53)

117/662
(18)

2.8(2.5 to 3.2)

For oral eletriptan 80 mg in six trials, 763/1221 patients (62%) had a headache response at two hours compared with 191/779 (25%) with placebo. The NNT was 2.6 (2.4 to 3.0). In six trials, 386/1221 patients (32%) were pain free at two hours compared with 38/779 (25%) with placebo. The NNT was 3.7 (3.4 to 4.2). In five trials, 618/1160 patients (53%) had a headache response at two hours, sustained for 24 hours with no rescue medication and no second dose of study medication compared with 117/662 (18%) with placebo. The NNT was 2.8 (2.5 to 3.2).

Oral eletriptan 40 mg

The results for the six trials for oral eletriptan 40 mg were consistent for all outcomes, and those for two hour headache response are shown in Figure 2.

Figure 2: Headache response at two hours for oral eletriptan 40 mg

Table 2: Results for oral eletriptan 40 mg

Number/total with outcome (%)

Outcome

Number of trials

Treatment

Placebo

NNT
(95%CI)

Two hour headache response

6

724/1221
(59)

191/779
(25)

2.9 (2.6 to 3.3)

Two hour pain free

6

335/1221
(27)

38/779
(5)

4.5 (3.9 to 5.1)

Headache response at 2 hours sustained to 24 hours

5

526/1160
(45)

117/662
(18)

3.6 (3.1 to 4.2)

For oral eletriptan 40 mg in six trials, 724/1224 patients (59%) had a headache response at two hours compared with 191/779 (25%) with placebo. The NNT was 2.9 (2.6 to 3.3). In six trials, 335/1224 patients (27%) were pain free at two hours compared with 38/779 (25%) with placebo. The NNT was 4.5 (3.9 to 5.1). In five trials, 526/1157 patients (45%) had a headache response at two hours, sustained for 24 hours with no rescue medication and no second dose of study medication compared with 117/662 (18%) with placebo. The NNT was 3.6 (3.1 to 4.2).

Oral eletriptan 20 mg

Table 3: Results for oral eletriptan 20 mg

Number/total with outcome (%)

Outcome

Number of trials

Treatment

Placebo

NNT
(95%CI)

Two hour headache response

2

157/349
(45)

78/353
(22)

4.4 (3.4 to 6.2)

Two hour pain free

2

52/349
(15)

17/353
(5)

10 (7 to 17)

Headache response at 2 hours sustained to 24 hours

1

53/144
(37)

26/142
(18)

5.4 (3.5 to 12)

For oral eletriptan 20 mg in two trials, 157/349 patients (45%) had a headache response at two hours compared with 78/353 (22%) with placebo. The NNT was 4.4 (3.4 to 6.2). In two trials, 52/349 patients (15%) were pain free at two hours compared with 17/353 (25%) with placebo. The NNT was 9.9 (6.9 to 17). In five trials, 53/144 patients (37%) had a headache response at two hours, sustained for 24 hours with no rescue medication and no second dose of study medication compared with 26/142 (18%) with placebo. The NNT was 5.4 (3.5 to 12).

Adverse effects

Adverse effects are not reported in any way that makes obvious sense because efficacy was measured over 24 hours and adverse events for up to 10 days.

Comment

Eletriptan is clearly effective in the treatment of acute migraine. At present it is not widely available around the world, but it does have good efficacy for the 24 hour outcome of sustained relief.