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Meta-Analysis
. 2014 May 21;2014(5):CD008616.
doi: 10.1002/14651858.CD008616.pub2.

Zolmitriptan for acute migraine attacks in adults

Sarah Bird  1 , Sheena Derry, R Andrew Moore
Affiliations
Meta-Analysis

Zolmitriptan for acute migraine attacks in adults

Sarah Bird et al. Cochrane Database Syst Rev. .

Abstract

Background: Migraine is a common, disabling condition and a burden for the individual, health services, and society. Zolmitriptan is an abortive medication for migraine attacks, belonging to the triptan family. These medicines work in a different way to analgesics such as paracetamol and ibuprofen.

Objectives: To determine the efficacy and tolerability of zolmitriptan compared to placebo and other active interventions in the treatment of acute migraine attacks in adults.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and the Oxford Pain Relief Database, together with three online databases (www.astrazenecaclinicaltrials.com, www.clinicaltrials.gov, and apps.who.int/trialsearch) for studies to 12 March 2014. We also searched the reference lists of included studies and relevant reviews.

Selection criteria: We included randomised, double-blind, placebo- or active-controlled studies, with at least 10 participants per treatment arm, using zolmitriptan to treat a migraine headache episode.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. We used numbers of participants achieving each outcome to calculate risk ratios and numbers needed to treat for an additional beneficial effect (NNT) or harmful effect (NNH) compared with placebo or a different active treatment.

Main results: Twenty-five studies (20,162 participants) compared zolmitriptan with placebo or an active comparator. The evidence from placebo-controlled studies was of high quality for all outcomes except 24 hour outcomes and serious adverse events where only limited data were available. The majority of included studies were at a low risk of performance, detection and attrition biases, but did not adequately describe methods of randomisation and concealment.Most of the data were for the 2.5 mg and 5 mg doses compared with placebo, for treatment of moderate to severe pain. For all efficacy outcomes, zolmitriptan surpassed placebo. For oral zolmitriptan 2.5 mg versus placebo, the NNTs were 5.0, 3.2, 7.7, and 4.1 for pain-free at two hours, headache relief at two hours, sustained pain-free during the 24 hours postdose, and sustained headache relief during the 24 hours postdose, respectively. Results for the oral 5 mg dose were similar to the 2.5 mg dose, while zolmitriptan 10 mg was significantly more effective than 5 mg for pain-free and headache relief at two hours. For headache relief at one and two hours and sustained headache relief during the 24 hours postdose, but not pain-free at two hours, zolmitriptan 5 mg nasal spray was significantly more effective than the 5 mg oral tablet.For the most part, adverse events were transient and mild and were more common with zolmitriptan than placebo, with a clear dose response relationship (1 mg to 10 mg).High quality evidence from two studies showed that oral zolmitriptan 2.5 mg and 5 mg provided headache relief at two hours to the same proportion of people as oral sumatriptan 50 mg (66%, 67%, and 68% respectively), although not necessarily the same individuals. There was no significant difference in numbers experiencing adverse events. Single studies reported on other active treatment comparisons but are not described further because of the small amount of data.

Authors' conclusions: Zolmitriptan is effective as an abortive treatment for migraine attacks for some people, but is associated with increased adverse events compared to placebo. Zolmitriptan 2.5 mg and 5 mg benefited the same proportion of people as sumatriptan 50 mg, although not necessarily the same individuals, for headache relief at two hours.

PubMed Disclaimer

Conflict of interest statement

RAM and SD have received research support from charities, government and industry sources at various times, none of which were related to this review. RAM has consulted for various pharmaceutical companies (including AstraZeneca, the manufacturers of zolmitriptan) and has received lecture fees from other pharmaceutical companies related to analgesics and other healthcare interventions, none of which were related to this review. SB has no interests to declare. AstraZeneca were not in any way involved in carrying out this review.

Figures

1
1
Flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Forest plot of comparison: 2 Zolmitriptan 2.5 mg versus placebo, outcome: 2.1 Pain‐free at 2 h. Studies without footnotes use the standard oral tablet.
4
4
L'Abbé plot showing results for zolmitriptan 2.5 mg versus placebo for pain‐free at 2 hours. Each circle represents a different study; size of circle is proportional to size of study; diagonal is line of equivalence
5
5
Forest plot of comparison: 2 Zolmitriptan 2.5 mg versus placebo, outcome: 2.2 Headache relief at 2 h. Studies without footnotes use the standard oral tablet.
6
6
L'Abbé plot showing results for zolmitriptan 2.5 mg versus placebo for headache relief at 2 hours. Each circle represents a different study; size of circle is proportional to size of study; diagonal is line of equivalence
See this image and copyright information in PMC

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