Naratriptan for acute migraine
Clinical bottom line
Naratriptan 2.5 mg is better than placebo but less effective than sumatriptan 100 mg and rizatriptan 10 mg for treating acute migraine attacks when measured four hours after the dose.
Reference
DM Ashcroft, D Millson. Naratriptan for the treatment of acute migraine: meta-analysis of randomised controlled trials. Pharmacoepidemiology and Drug safety 2004 13: 73-82.
Background
Naratriptan is a widely prescribed triptan for treating acute migraine attacks. While most studies in acute migraine have concentrated on speedy pain relief, with outcomes at two hours after doing in patients with at least moderate pain, the trials of naratriptan have predominantly measured outcomes at four hours. This tends to make a drug look somewhat better than when outcomes are measured after two hours.
Methods of the review
- Date review completed: October 2002
- Number of trials included: 10 trials; randomised, mostly double blind, with a mix of measuring effects after 1-4 migraine attacks.
- Number of patients: 4499
- Control groups: Placebo, with some active comparators
- Main outcomes: headache response and pain free after four hours, with sustained response over 4-24 hours with no additional therapy
Results
Comparisons with placebo are shown in Table 1 for all outcomes and for naratriptan 1 mg and 2.5 mg. Lower (better) NNTs were seen with higher dose and with less difficult outcomes like headache response. Results were consistent between trials, as Figure 1 demonstrates for the outcome of headache response at four hours for naratriptan 2.5 mg.
Table 1: Results for different outcomes with naratriptan 1 and 2.5 mg in acute migraine
|
Number
of
|
Percent
with
|
||||
| Outcome |
Trials |
Patients |
Naratriptan |
Placebo |
NNT (95%CI) |
| Naratriptan 1 mg | |||||
| Headache response 4 hours | 3 |
1938 |
55 |
33 |
4.5
(3.8 to 5.6) |
| Pain free 4 hours | 3 |
1938 |
32 |
16 |
6.5
(5.3 to 8.6) |
| Sustained response 4-24 hours | 3 |
1938 |
35 |
20 |
6.8 (5.4 to 9.3) |
| Naratriptan 2.5 mg | |||||
| Headache response 4 hours |
6 |
2358 |
64 |
31 |
3.1 (2.7 to 3.5) |
| Pain free 4 hours |
6 |
2358 |
41 |
15 |
4.0 (3.5 to 4.6) |
| Sustained response 4-24 hours |
6 |
2358 |
44 |
19 |
3.9 (3.4 to 4.5) |
Figure 1: Naratriptan 2.5 mg: headache response at 4 hours
In comparisons with sumatriptan 100 mg and rizatriptan 10 mg, naratriptan 1 m and 2.5 mg were less effective at four hours. There was no difference between naratiptan 2.5 mg and zolmitriptan 2.5 mg.
Comment
These results are difficult to compare with those of other interventions for acute migraine that used more conventional (and probably more relevant) two hour outcomes. Limited information at two hours indicates that naratriptan 2.5 mg is considerably less efficacious than other triptans at usual doses.