Comparison of rizatriptan and other triptans on stringent measures of efficacy

Objective: To compare the efficacy of oral rizatriptan 10 mg with oral dose s of sumatriptan, naratriptan, and zolmitriptan on stringent outcome measur es. Methods: Retrospective analysis of data from five randomized, placebo-c ontrolled, double-masked clinical trials in which oral rizatriptan was dire ctly compared with oral sumatriptan 100 mg (n = 772), 50 mg (n = 1116), 25 mg (n = 1183), naratriptan 2.5 mg (n = 413), and zolmitriptan 2.5 mg (n = 5 80) for the acute treatment of a moderate or severe migraine attack. Outcom e measures: Percentage of patients pain-free at 2 hours, symptom-free at 2 hours (no pain, nausea, photophobia, phonophobia, vomiting, or functional d isability), 24-hour sustained pain-free (no headache at 2 hours, no recurre nce, and no additional antimigraine medications for 24 hours). Results: Mor e patients taking rizatriptan 10 mg were pain-free at 2 hours than were pat ients taking sumatriptan 100 mg (40% vs 33%, p = 0.019), sumatriptan 50 mg (40% vs 35%, p = 0.009), sumatriptan 25 mg (38% vs 27%, p < 0.001), naratri ptan 2.5 mg (45% vs 21%, p < 0.001), and zolmitriptan 2.5 mg (43% vs 36%, p = 0.041). More patients taking rizatriptan 10 mg were symptom-free at 2 ho urs than were patients taking sumatriptan 100 mg (31% vs 22%, p = 0.002), s umatriptan 50 mg (33% vs 28%, p = 0.003), sumatriptan 25 mg (33% vs 24%, p < 0.001), naratriptan 2.5 mg (30% vs 11%, p < 0.001), and zolmitriptan 2.5 mg (31% vs 24%, p = 0.042). More patients taking rizatriptan 10 mg had a 24 -hour sustained pain-free response than did patients taking sumatriptan 100 mg (27% vs 23%, p = 0.112), sumatriptan 50 mg (30% vs 26%, p = 0.015), sum atriptan 25 mg (27% vs 20%, p = 0.005), naratriptan 2.5 mg (29% Vs 17%, p = 0.004), and zolmitriptan 2.5 mg (32% vs 24%, p = 0.013). Conclusion: Oral rizatriptan 10 mg was more effective than oral sumatriptan, naratriptan, an d zolmitriptan on stringent outcome measures of pain-free response at 2 hou rs; symptom-free response at 2 hours, and 24-hour sustained pain-free respo nse.