EFFICACY AND ADVERSE EVENTS OF SUBCUTANEOUS, ORAL, AND INTRANASAL SUMATRIPTAN USED FOR MIGRAINE TREATMENT - A SYSTEMATIC REVIEW BASED ON NUMBER NEEDED TO TREAT
P. Tfelthansen, EFFICACY AND ADVERSE EVENTS OF SUBCUTANEOUS, ORAL, AND INTRANASAL SUMATRIPTAN USED FOR MIGRAINE TREATMENT - A SYSTEMATIC REVIEW BASED ON NUMBER NEEDED TO TREAT, Cephalalgia, 18(8), 1998, pp. 532-538
Objectives: To evaluate the efficacy, speed of onset, and adverse even
ts of 6 mg subcutaneous, 100 mg oral, and 20 mg intranasal sumatriptan
in the treatment of migraine attacks. Design: Systematic review of pl
acebo-controlled randomized clinical trials. Data sources: Thirty tria
ls up to April 1997 retrieved from a systematic literature search (Med
line, review papers, handsearching of journals, congress proceedings,
manufacturer's database); no restriction on language. Outcome paramete
rs: Numbers needed to heat (NNT) were calculated for relief of headach
e and for adverse events (when data were available). Therapeutic gain
was used to evaluate speed of onset of action. Results: Subcutaneous s
umatriptan was more efficacious, combined number needed to treat 2.0 a
t 1 h, than oral (3.0 at 2 h) and intranasal sumatriptan (3.1 at 2 h).
For adverse events, the NNT was 3.0 for subcutaneous and 8.3 for oral
sumatriptan. Only limited data on adverse events for intranasal sumat
riptan were available. Therapeutic gain analysis during the first 2 h
showed that subcutaneous sumatriptan was the fastest-acting form of ad
ministration. Conclusions: Subcutaneous sumatriptan in a dose of 6 mg
is significantly more efficacious than 100 mg of oral sumatriptan, but
causes more adverse events than oral sumatriptan. Subcutaneous sumatr
iptan is the form with the quickest onset of action. Intranasal sumatr
iptan has the same efficacy as oral sumatriptan and a quicker onset of
action than the oral form, but with a limited therapeutic effect for
the first 30 min after administration.