Rk. Cady et al., Effect of early intervention with sumatriptan on migraine pain: Retrospective analyses of data from three clinical trials, CLIN THER, 22(9), 2000, pp. 1035-1048
Objective: This study assessed the efficacy of sumatriptan 50- and 100-mg t
ablets in the treatment of migraine attacks while the pain is mild rather t
han moderate/severe.
Background: Results from The Spectrum Study suggested that early treatment
of migraine attacks with sumatriptan 50-mg tablets while the pain is mild m
ight enhance pain-free response and reduce headache recurrence.
Methods: Retrospective analyses of headaches treated during mild pain were
performed using data from 3 studies of sumatriptan tablets (protocols S2CM0
9, S2BT25, and S2BT26). Our primary interest was pain-free response 2 and 4
hours after dosing; secondary interests were use of a second dose of medic
ation, clinical disability (as measured on a 4-point disability scale), mig
raine-associated symptoms, meaningful pain relief (patient defined), time t
o meaningful relief, sustained pain-free response, and proportion of attack
s in which pain had worsened 2 and 4 hours after dosing, all of which were
compared in headaches treated during mild versus moderate/severe pain.
Results: In S2CM09, 92 patients treated 118 headaches during mild pain. Rat
es of pain-free response were higher 2 hours after dosing with sumatriptan
50 mg (51%) or 100 mg (67%; P < 0.05) compared with placebo (28%), and were
higher with early treatment of mild pain compared with treatment of modera
te/severe pain at 2 hours (sumatriptan 50 mg: mild pain, 51%; moderate/seve
re pain, 31%; P < 0.05; sumatriptan 100 mg: mild pain, 67%; moderate/severe
pain, 36%) and 4 hours (50 mg: 75% vs 56%; 100 mg: 90% vs 61%; P < 0.05).
Early intervention also resulted in less redosing than when moderate/severe
pain was treated (50 mg: 21% vs 32%; 100 mg: 20% vs 29%). More attacks tre
ated early with sumatriptan 50 or 100 mg were associated with normal functi
on 4 hours after dosing compared with placebo (70% and 93% vs 46%, respecti
vely). Sustained pain-free response rates 2 to 24 hours after early dosing
with sumatriptan 50 or 100 mg were also higher (34% and 53%, respectively)
compared with treatment of moderate/severe pain (19% and 24%, respectively)
. Early treatment with sumatriptan 100 mg produced significantly higher pai
n-free rates at 2 hours after dosing (P < 0.001) than did ergotamine plus c
affeine (S2BT25: 69% vs 34%, respectively) or aspirin plus metoclopramide (
S2BT26: 73% vs 25%, respectively).
Conclusions: Sumatriptan 50- and 100-mg tablets are effective whether pain
is mild or moderate/severe. However, treatment with sumatriptan while pain
is mild provides high pain-free response rates while reducing the need for
redosing, benefits not seen with ergotamine plus caffeine or aspirin plus m
etoclopramide.