Title: The clinical and financial impact of oral triptans - an updated meta-analysis
Abstract: SummaryIn a previous meta-analysis we demonstrated that rizatriptan 10 mg is a clinically and cost-effective treatment option in acute migraine, when compared with other available oral triptans. The current paper updates this analysis, to include data for almotriptan and eletriptan.A literature search identified all placebo-controlled randomised clinical trials involving oral triptans published up to February 2002. The proportion of patients rendered pain-free over 2 hours was identified for each agent, and the results pooled using a random-effects model. Numbers needed to treat (NNT) were calculated for each agent. Using current UK drug costs, an estimate of the expenditure required per patient rendered pain free at 2 hours was also made.Twenty-nine studies, involving 45 active treatment arms were identified. Based on the NNT analysis, significantly more patients achieved pain-free status at 2 hours with rizatriptan 10 mg than with sumatriptan 100 mg (p<0.02), sumatriptan 50 mg (p<0.01) eletriptan 40 mg (p<0.01), zolmitriptan 2.5 mg (p<0.05), almotriptan 12.5 mg (p<0.01) and naratriptan 2.5 mg (p<0.001). There was no significant difference between rizatriptan 10 mg, eletriptan 80 mg and zolmitriptan 5 mg for this endpoint. Based on acquisition costs alone, there was a statistically significant difference between the cost-effectiveness ratios of rizatriptan 10 mg (£14.15) and sumatriptan 100 mg (£37.61; p<0.001), zolmitriptan 5 mg (£33.26; p<0.001), naratriptan 2.5 mg (£32.66; p<0.01), sumatriptan 50 mg (£28.71; p<0.001) and eletriptan 80 mg (£28.17; p<0.001). There was no significant difference between the cost-effectiveness ratios calculated for rizatriptan 10 mg and almotriptan 12.5 mg (£15.06), eletriptan 40 mg (£17.37) and zolmitriptan 2.5 mg (£20.22).Rizatriptan 10 mg is the only agent studied that demonstrated high levels of both clinical and cost-effectiveness. It can therefore be considered an ideal first-line treatment choice in the management of the acute migraine attack.