Oral Rizatriptan Versus Oral Sumatriptan: A Direct Comparative Study in the Acute Treatment of Migraine
Rizatriptan is a potent, oral, 5-HT1B/1D agonist with more rapid absorption and higher bioavailability than oral sumatriptan. It was postulated that this would result in more rapid onset of effect. This randomized, double-blind, triple-dummy, parallel-groups study compared rizatriptan 5 mg, rizatriptan 10 mg, sumatriptan 100 mg, and placebo in 1268 outpatients treating a single migraine attack. Headache relief rates after rizatriptan 10 mg were consistently higher than sumatriptan at all time points up to 2 hours, with significance at 1 hour (37% versus 28%, P=0.010). All active agents were significantly superior to placebo with regard to headache relief and pain freedom at 2 hours (P≤0.001). The primary efficacy endpoint of time to pain relief through 2 hours demonstrated that, after adjustment for age imbalance, rizatriptan 10 mg had earlier onset than sumatriptan 100 mg (P=0.032; hazard ratio 1.21). Rizatriptan 10 mg was also superior to sumatriptan on pain-free response (P=0.032), reduction in functional disability (P=0.015), and relief of nausea at 2 hours (P=0.010). Significantly fewer drug-related clinical adverse events were reported after rizatriptan 10 mg (33%, P=0.014) compared with sumatriptan 100 mg (41%). We conclude that rizatriptan 10 mg has a rapid onset of action and relieves headache and associated symptoms more effectively than sumatriptan 100 mg.
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Document Type: Research Article
From Bispebjerg Hospital, Copenhagen, Denmark (Dr. Tfelt-Hansen);
Merck & Co. Inc, West Point, Penn (Ms. Teall and Drs. Block, Reines, and Visser);
Fundacion Instituto Neurologico de Columbia, Bogota, Colombia (Dr. Rodriguez);
Universita degli Studi di Roma, Rome, Italy (Dr. Giacovazzo);
San Borja, Lima, Peru (Dr. Paz); and
Merck, Sharp & Dohme (Europe), Inc, Brussels, Belgium (Dr. Malbecq).
November 1, 1998