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Rizatriptan vs Sumatriptan in the Acute Treatment of Migraine:  A Placebo-Controlled, Dose-Ranging Study

W. Hester Visser, MD, PhD; Gisela M. Terwindt, MD; Scott A. Reines, MD, PhD; Kai Jiang, PhD; Chris R. Lines, PhD; Michel D. Ferrari, MD, PhD
Arch Neurol. 1996;53(11):1132-1137. doi:10.1001/archneur.1996.00550110072014.
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Background:  Rizatriptan (MK-462) is a new 5-hydroxytryptamine1D (serotonin1D; 5-HT1D) receptor agonist for the acute treatment of migraine that has improved pharmacokinetic properties compared with sumatriptan succinate.

Objective:  To assess the efficacy and tolerability of 10-, 20-, and 40-mg doses of oral rizatriptan vs a 100-mg dose of oral sumatriptan succinate and placebo for the acute treatment of migraine.

Design:  Randomized, double-blind, parallel-group, placebo-controlled, outpatient trial.

Setting:  Ten US and 4 Dutch investigator centers.

Patients:  Patients who had migraine with or without aura (N=449).

Main Outcome Measure:  The proportion of patients whose conditions improved from severe or moderate headache immediately before dosing to mild or no headache at 2 hours after drug administration (ie, headache relief).

Results:  The proportion of patients with headache relief was 18% for placebo; 46% for sumatriptan; and 52% for 10-mg, 56% for 20-mg, and 67% for 40-mg rizatriptan. All differences with placebo were statistically significant (P<.001), and 40-mg rizatriptan was superior to sumatriptan (P=.01). The proportion of patients who became free of pain at 2 hours was 3% for the placebo-treated group; 22% for the sumatriptan-treated group; and 26%, 35%, and 47% for the group of patients who took the 10-, 20-, and 40-mg doses of rizatriptan, respectively (all differences with placebo, P<.005; 40-mg rizatripan vs sumatriptan, P=.001). The recurrence of headache within 24 hours was found to be equal across all treatment groups—approximately 40%. Adverse events (most commonly short-lasting mild or moderate dizziness and drowsiness) occurred more frequently after a 40-mg dose of rizatriptan was given than after the other treatments.

Conclusions:  The antimigraine effect of 10- and 20-mg rizatriptan was superior to placebo, and comparable with that of 100-mg sumatriptan succinate; the efficacy of 40-mg rizatriptan was superior to that of both placebo and 100-mg sumatriptan succinate, although it was associated with a high frequency of adverse events.

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