Randomized, double-blind, crossover study comparing DFN-11 injection (3 mg subcutaneous sumatriptan) with 6 mg subcutaneous sumatriptan for the treatment of rapidly-escalating attacks of episodic migraine
Roger K Cady, Sagar Munjal, Ryan J Cady, Heather R Manley, Elimor Brand-Schieber, Roger K Cady, Sagar Munjal, Ryan J Cady, Heather R Manley, Elimor Brand-Schieber
Abstract
Background: A 6-mg dose of SC sumatriptan is the most efficacious and fast-acting acute treatment for migraine, but a 3-mg dose of SC sumatriptan may improve tolerability while maintaining efficacy.
Methods: This randomized, double-blind, crossover study compared the efficacy and tolerability of 3 mg subcutaneous (SC) sumatriptan (DFN-11) with 6 mg SC sumatriptan in 20 adults with rapidly-escalating migraine attacks. Eligible subjects were randomized (1:1) to treat 1 attack with DFN-11 and matching placebo autoinjector consecutively or 2 DFN-11 autoinjectors consecutively and a second attack similarly but with the alternative dose (3 mg or 6 mg).
Results: The proportions of subjects who were pain-free at 60 min postdose, the primary endpoint, were similar following treatment with 3 mg SC sumatriptan and 6 mg SC sumatriptan (50% vs 52.6%, P = .87). The proportions of subjects experiencing pain relief (P ≥ .48); reductions in migraine pain intensity (P ≥ .78); and relief from nausea, photophobia, or phonophobia (P ≥ .88) with 3 mg SC sumatriptan and 6 mg SC sumatriptan were similar, as were the mean scores for satisfaction with treatment (M = 2.6 vs M = 2.4, P = .81) and the mean number of rescue medications used (M = .11 vs M = .26, P = .32). The most common adverse events with the 3- and 6-mg doses were triptan sensations - paresthesia, neck pain, flushing, and involuntary muscle contractions of the neck - and the incidence of adverse events with both doses was similar (32 events total: 3 mg, n = 14 [44%]; 6 mg, n = 18 [56%], P = .60). Triptan sensations affected 4 subjects with the 6-mg dose only, 1 subject with the 3-mg dose only, and 7 subjects with both sumatriptan doses. Chest pain affected 2 subjects (10%) treated with the 6-mg dose and no subjects (0%) treated with the 3-mg dose of DFN-11. There were no serious adverse events.
Conclusions: The 3-mg SC dose of sumatriptan in DFN-11 provided relief of migraine pain and associated symptoms comparable to a 6-mg SC dose of sumatriptan. Tolerability was similar with both study medications; DFN-11 treatment was associated with fewer triptan sensations than the 6-mg dose. DFN-11, with its 3-mg dose of sumatriptan, may be a clinically useful alternative to higher-dose autoinjectors.
Keywords: Episodic; Migraine; Rapidly-escalating; Subcutaneous; Sumatriptan; Treatment.
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References
- Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia. 2013;33:629–808. doi: 10.1177/0333102413485658.
- Lionetto L, Negro A, Casolla B, et al. Sumatriptan succinate: pharmacokinetics of different formulations in clinical practice. Expert Opin Pharmacother. 2012;13:2369–2380. doi: 10.1517/14656566.2012.730041.
- Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343–349. doi: 10.1212/01.wnl.0000252808.97649.21.
- Stewart WF, Lipton RB, Celentano DD, et al. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. 1992;267:64–69. doi: 10.1001/jama.1992.03480010072027.
- Lipton RB, Stewart WF, Diamond S, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41:646–657. doi: 10.1046/j.1526-4610.2001.041007646.x.
- World Health Organization. Global Health Estimates 2014 summary tables. YLD Global 2000–2012, June 2014. Available at: . Accessed 3 Dec 2016.
- Dowson AJ, Sender J, Lipscombe S, et al. Establishing principles for migraine management in primary care. Int J Clin Pract. 2003;57:493–507.
- Ferrari MD, Roon KI, Lipton RB, et al. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001;358:1668–1675. doi: 10.1016/S0140-6736(01)06711-3.
- Napoletano F, Lionetto L, Martelletti P. Sumatriptan in clinical practice: effectiveness in migraine and the problem of psychiatric comorbidity. Expert Opin Pharmacother. 2014;15:303–305. doi: 10.1517/14656566.2014.858120.
- Cady RK, Wendt JK, Kirchner JR, et al. Treatment of acute migraine with subcutaneous sumatriptan. JAMA. 1991;265:2831–2835. doi: 10.1001/jama.1991.03460210077033.
- The Subcutaneous Sumatriptan International Study Group Treatment of migraine attacks with sumatriptan. N Engl J Med. 1991;325:316–321. doi: 10.1056/NEJM199108013250504.
- Erlichson K, Waight J. Therapeutic applications for subcutaneous triptans in the acute treatment of migraine. Curr Med Res Opin. 2012;28:1231–1238. doi: 10.1185/03007995.2012.674501.
- IMITREX (sumatriptan succinate) Injection prescribing information. Available at: . Accessed 3 Dec 2016.
- Mathew NT, Dexter J, Couch J, et al. Dose ranging efficacy and safety of subcutaneous sumatriptan in the acute treatment of migraine. US Sumatriptan Research Group. Arch Neurol. 1992;49:1271–1276. doi: 10.1001/archneur.1992.00530360073020.
- Gallagher RM, Kunkel R. Migraine medication attributes important for patient compliance: concerns about side effects may delay treatment. Headache. 2003;43:36–43. doi: 10.1046/j.1526-4610.2003.03006.x.
- Goadsby PJ, Lipton RB, Ferrari MD. Migraine--current understanding and treatment. N Engl J Med. 2002;346:257–270. doi: 10.1056/NEJMra010917.
- Gendolla A. Part I: what do patients really need and want from migraine treatment? Curr Med Res Opin. 2005;21(Suppl 3):S3–S7. doi: 10.1185/030079905X46269.
- Lipton RB, Hamelsky SW, Dayno JM. What do patients with migraine want from acute migraine treatment? Headache. 2002;42(Suppl 1):3–9. doi: 10.1046/j.1526-4610.2002.0420s1003.x.
- Winner P, Adelman J, Aurora S, et al. Efficacy and tolerability of sumatriptan injection for the treatment of morning migraine: two multicenter, prospective, randomized, double-blind, controlled studies in adults. Clin Ther. 2006;28:1582–1591. doi: 10.1016/j.clinthera.2006.10.011.
- Landy SH, Mcginnis JE, Mcdonald SA. Pilot study evaluating preference for 3-mg versus 6-mg subcutaneous sumatriptan. Headache. 2005;45:346–349. doi: 10.1111/j.1526-4610.2005.05072.x.
- Visser WH, Jaspers NM, De Vriend RH, et al. Chest symptoms after sumatriptan: a two-year clinical practice review in 735 consecutive migraine patients. Cephalalgia. 1996;16:554–559. doi: 10.1046/j.1468-2982.1996.1608554.x.
- Wang JT, Barr CE, Goldfarb SD. Impact of chest pain on cost of migraine treatment with almotriptan and sumatriptan. Headache. 2002;42(Suppl 1):38–43. doi: 10.1046/j.1526-4610.2002.0420s1038.x.
- Burstein R, Jakubowski M. Analgesic triptan action in an animal model of intracranial pain: a race against the development of central sensitization. Ann Neurol. 2004;55:27–36. doi: 10.1002/ana.10785.
- Cady RK, Sheftell F, Lipton RB, et al. Effect of early intervention with sumatriptan on migraine pain: retrospective analyses of data from three clinical trials. Clin Ther. 2000;22:1035–1048. doi: 10.1016/S0149-2918(00)80083-1.
- Winner P, Mannix LK, Putnam DG, et al. Pain-free results with sumatriptan taken at the first sign of migraine pain: 2 randomized, double-blind, placebo-controlled studies. Mayo Clin Proc. 2003;78:1214–1222. doi: 10.4065/78.10.1214.
- Cady RK, Lipton RB, Hall C, et al. Treatment of mild headache in disabled migraine sufferers: results of the Spectrum Study. Headache. 2000;40:792–797. doi: 10.1046/j.1526-4610.2000.00144.x.
Source: PubMed