In a big-data analysis of 25 acute migraine medications, triptans, ergots, and anti-emetics emerged as the most effective medications.
In a big-data analysis simultaneously comparing 25 acute migraine medications head to head, with records for close to 11 million patients, triptans, ergots, and anti-emetics emerged as the most effective medications.
A head-to-head comparison of treatment effectiveness based on real-world patient experience of this scale had not been performed before. The American-Japanese group had consented access to more than 10 million records of migraine attacks that had been gathered through a smartphone application called Migraine Buddy, which features an e-diary. A filtering criterium was “English speaking user.” The researchers focused on 25 acute medications in seven classes: acetaminophen, NSAIDs, triptans, combination analgesics, ergotamines, anti-emetics, and opioids. Due to the relatively low number of users, gepants and ditan were not included in the analysis. The study team used a two-level nested logistic regression model to estimate for each medication the OR of effectiveness, after adjusting for pain intensity, and other concurrent medications, as well as covariance within the same user.
The final analysis included more than 4.7 million medication outcome pairs from 3.1 million migraine attacks among 278,006 users. Ibuprofen was used as the reference. Triptans were found to have the highest efficacy, with a mean OR of 4.8, followed by ergotamines (OR, 3.02) and anti-emetics (OR, 2.67), opioids (OR, 2.49), NSAIDs (OR, 1.94), acetaminophen/acetylsalicylic acid/caffeine (OR, 1.69), others (OR, 1.49), and acetaminophen (OR, 0.83). Individual medications with the highest ORs were eletriptan (OR, 6.1), zolmitriptan (OR, 5.7), and sumatriptan (OR, 5.2). All estimated ORs were statistically significant, except that of acetylsalicylic acid. The nested logistic regression model achieved an excellent area under the curve of 0.849.
The researchers said their results offer generalizable insights that complement clinical practice.
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