From Hell to the Light at the End of the Tunnel – A Task for Eletriptan
In recent months, under the spotlight of new biological treatments, the focus has been predominantly on the prophylactic treatment of migraines. However, we should not forget about acute therapy. In this indication, the pharmacological group of triptans is dominant. So, does eletriptan reliably stop the hell named a migraine attack? And is the response to this drug consistent?
Triptans as a Clear First Choice
With the arrival of triptans in the Czech Republic in 1993, a significant breakthrough occurred in the therapy of this neurological disease. The introduction of specific, selectively acting antimigraine agents significantly improved the therapeutic options for managing moderate and severe migraine attacks. Triptans are also the first-line treatment for mild attacks that do not respond to analgesics or nonsteroidal anti-inflammatory drugs.
The antimigraine effect of triptans is complex. They stimulate serotonin receptors, thus causing selective vasoconstriction of dilated subdural cerebral arteries. They also block the release of vasoactive peptides, thereby inhibiting the development of perivascular neurogenic inflammation. Additionally, triptans increase the sensory threshold of neurons in the trigeminovascular complex, which prevents the transmission of painful stimuli to the locus coeruleus and nucleus raphe dorsalis (“migraine generator”).
The King Among Triptans
A meta-analysis of 74 studies showed that compared to all other triptans, eletriptan is always more effective in at least one of two evaluated parameters (achieving a pain-free state within 2 hours, maintaining a pain-free state for 24 hours, reducing headache pain within 2 hours, and maintaining reduced pain for 24 hours). According to the results of this meta-analysis, patients using eletriptan have the highest probability of achieving a pain-free state within 2 hours and maintaining it for 24 hours.
A Comet or a Steady Star?
Does eletriptan behave like a comet that shines brightly and then fades, or is it consistently effective? American authors sought to answer this question in their work published in the journal Cephalalgia. They focused on the consistency of the response to eletriptan across 3 migraine attacks in individual patients.
A double-blind study conducted between March 2000 and 2002 included a total of 1191 patients aged 18–65 years. Out of a total of 4 migraine attacks experienced, 3 were randomly treated with eletriptan at a dose of 40 or 80 mg (based on previous titration of the adequate dose) and 1 with placebo. The effects on pain within 2 hours of medication, the achievement of a pain-free state within 2 hours, maintaining a pain-free state for 24 hours, the need for additional rescue medication within 2 hours of taking eletriptan, the return of pain within 24 hours of taking eletriptan, patient preference in terms of therapy choice, and patient satisfaction with eletriptan treatment were evaluated.
The probability of reducing headache pain within 2 hours of taking eletriptan ranged from 71 to 74% for the 40 mg dose (compared to 17–28% for placebo) and from 66 to 74% for the 80 mg dose (compared to 21–27% for placebo). The incidence of adverse events was minimal and corresponded to previously published results. Eletriptan did not disappoint and demonstrated a strong and consistent response in migraine therapy.
A Bet on Certainty and Stability
Triptans are rightfully the gold standard in acute migraine therapy. As a second-generation triptan, eletriptan is among the most effective representatives of this drug group. It has also been proven to have a consistent response over time, coupled with a good safety profile.
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Sources:
1. Almas M., Tepper S. J., Landy S. et al. Consistency of eletriptan in treating migraine: results of a randomized, within-patient multiple-dose study. Cephalalgia 2014; 34 (2): 126–135, doi: 10.1177/0333102413500726.
2. Capi M., Curto M., Lionetto L. et al. Eletriptan in the management of acute migraine: an update on the evidence for efficacy, safety, and consistent response. Ther Adv Neurol Disord 2016; 9 (5): 414–423, doi: 10.1177/1756285616650619.
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