Triptans, also called serotonin 5-hydroxytryptamine (5-HT)(1B/1D) agonists, are used to treat migraine and certain other headaches. Triptans act by binding to serotonin receptors in the brain, which leads to a reversal of blood vessel swelling. Triptans may be taken subcutaneously, orally as tablets, capsules, or quick-dissolving wafers, or intranasally as a spray. Currently, 7 triptans are available in the United States (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan), as well as a fixed-dose combination product containing sumatriptan plus naproxen. Comparing the clinical efficacy and harms of the different triptans has been an area of considerable interest to researchers and patients, but is complex because of the large variety of outcome measures that can be measured in studies. The purpose of this review is to compare the efficacy, effectiveness, and harms of triptans.

Contents

• Introduction
  • Purpose and Limitations of Systematic Reviews
  • Scope and Key Questions
  • Inclusion Criteria
• Methods
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Validity Assessment
  • Data Synthesis
• Results
  • Overview
  • Summary of Findings
  • Detailed Assessment
• Summary
• References
• Appendix A. Glossary
• Appendix B. Search strategy
• Appendix C. Quality assessment for the Drug Effectiveness Review Project
• Appendix D. Excluded studies
• Appendix E. Pooled relative risks (95% confidence interval) for pain-free outcomes in placebo-controlled trials of early treatment with triptans
• Appendix F. Adverse events in head-to-head trials of triptans
• Evidence Tables

Update 3: November 2005
Update 2: September 2004
Update 1: December 2003
Original Report: March 2003

The medical literature relating to this topic is scanned periodically. (See http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/about/methods.cfm for description of scanning process). Prior versions of this report can be accessed at the DERP website.

The funding source, the Center for Evidence-based Policy, is supported by 14 organizations, including 13 state Medicaid programs. These organizations selected the topic and had input into the Key Questions for this review. The content and conclusions of the review are entirely determined by the Evidence-based Practice Center researchers. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in this report.

Suggested citation:

Helfand M, Peterson K. Drug class review: Triptans. Update 4. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.