| Sumario: | Background The Norwegian Knowledge Centre for the Health Service (NOKC) was requested by the Norwegian Medicines Agency to do a health technology assessment (HTA) on the efficacy and safety of 5HT1B/D receptor agonists, triptans, for the treatment of migraine disorders. Migraine has a one-year prevalence of 16-18% in women and 6-9% in men in Europe. A migraine attack usually lasts between 4 and 72 hours and recurrent attacks can affect daily functioning and quality of life. Triptans, selective 5HT1B/D receptor agonists, are today the main treatment option for migraine sufferers. There are seven different triptans available in Norway and these are used in the treatment of single migraine attacks in patients aged between 18 and 65 years. Objective This report is a systematic review of randomised, controlled head-to-head trials of various triptans to document comparative effectiveness and safety in adult patients with migraine. Methods Systematic searches were performed after published systematic reviews and randomised controlled trials in international databases. The literature was evaluated in a stepwise manner according to general principles of HTA. Studies that fulfilled our predetermined inclusion criteria were assessed and summarized. The work was reviewed by two independent external professionals. Results Sixteen randomised, controlled head-to-head trials were identified and met the inclusion criteria. The majority of the head-to-head trials involved and oral sumatriptan comparator. Our main findings are summarized below:1. Rizatriptan 10 mg is superior to sumatriptan 100 mg, naratriptan 2.5 mg and zolmitriptan 2.5 mg for the outcome 2-hour painfree.2. There is no significant difference between rizatriptan 10 mg, naratriptan 2.5 mg and zolmitriptan 2.5 mg for the outcome 24 hours sustained relief.3. The available head-to-head trials do not examine rizatriptan 10 mg and sumatriptan 100 mg for the outcome 24 hour sustained relief. Therefore, evidence is insufficient to judge the overall balance of advantages and disadvantages of this comparison.4. Head-to-head trials of various triptans with short follow-up period (24 hours) did not show significant differences in the reported adverse events frequencies. Comments We conclude that only small differences in efficacy can be documented between the various triptans in this systematic review. Rizatriptan 10 mg is superior to the other triptans for the outcome 2-hour painfree and have comparable effect for the outcome 24 hour sustained relief. Triptans are generally equally safe and well tolerated in the treatment of migraine patients. Future head-to-head trials should include more comparisons among triptans other than sumatriptan and should use currently recommended doses.
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