TY - JOUR
T1 - Triptan nonresponders
T2 - Do they exist and who are they?
AU - Viana, Michele
AU - Genazzani, Armando A.
AU - Terrazzino, Salvatore
AU - Nappi, Giuseppe
AU - Goadsby, Peter J.
N1 - Funding Information:
MV, AAG, ST and GN have no conflicts of interest. PJG is on the boards of Allergan, Colucid, MAP Pharmaceuticals, Merck, Sharpe and Dohme, eNeura, Neuroaxon, Autonomic Technologies Inc, Boston Scientific, Eli Lilly, Medtronic, Linde Gases, Arteaus, AlderBio and BristolMyerSquibb. He has consulted for Gammacore, Pfizer, Nevrocorp, Lundbeck, Zogenix, Impax and Dr Reddy, and has been compensated for expert legal testimony. He has received grant support from GlaxoSmithKline, MAP, MSD, eNeura and Amgen. He has received honoraria for speaking from MSD, Pfizer, Allergan and Mennarini, and payment for editorial work from Journal Watch Neurology and for developing educational materials for the American Headache Society.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Triptans represent the best treatment option for most migraine attacks, although this is not as well studied as it might be in controlled trials. Their efficacy and tolerability vary, both between agents, and from patient to patient, with about 30%-40% of patients not responding adequately to therapy. As yet unexplained, the failure of one triptan does not predict failure with another, and therefore triptan nonresponders cannot be defined as individuals who have failed a single triptan. Five clinical studies provide evidence that switching from a triptan that is ineffective to a second one can result in effective treatment in a proportion of patients. Systematic studies investigating whether there are patients who do not respond to all triptans in all formulations are lacking. Methods: Here we discuss the importance of identifying triptan nonresponders, the literature supporting their existence, and the issues to be resolved to design trials to investigate this. Conclusion: So far, no scientific data about the presence of a triptan nonresponder population are available.We propose a pragmatic study design to assess the existence of this subpopulation, recognizing the complexity of the question and the likelihood that more than one issue is at play in nonresponders.
AB - Background: Triptans represent the best treatment option for most migraine attacks, although this is not as well studied as it might be in controlled trials. Their efficacy and tolerability vary, both between agents, and from patient to patient, with about 30%-40% of patients not responding adequately to therapy. As yet unexplained, the failure of one triptan does not predict failure with another, and therefore triptan nonresponders cannot be defined as individuals who have failed a single triptan. Five clinical studies provide evidence that switching from a triptan that is ineffective to a second one can result in effective treatment in a proportion of patients. Systematic studies investigating whether there are patients who do not respond to all triptans in all formulations are lacking. Methods: Here we discuss the importance of identifying triptan nonresponders, the literature supporting their existence, and the issues to be resolved to design trials to investigate this. Conclusion: So far, no scientific data about the presence of a triptan nonresponder population are available.We propose a pragmatic study design to assess the existence of this subpopulation, recognizing the complexity of the question and the likelihood that more than one issue is at play in nonresponders.
KW - Triptan
KW - migraine
KW - nonresponder
KW - population
KW - predictor
KW - responder
UR - http://www.scopus.com/inward/record.url?scp=84879979228&partnerID=8YFLogxK
U2 - 10.1177/0333102413480756
DO - 10.1177/0333102413480756
M3 - Review article
SN - 0333-1024
VL - 33
SP - 891
EP - 896
JO - Cephalalgia
JF - Cephalalgia
IS - 11
ER -