Rizatriptan vs sumatriptan in the acute treatment of migraine - A placebo-controlled, dose-ranging study

Background: Rizatriptan (MK-462) isa new 5-hydroxytryptamine(1D) (serotonin(1D); 5-HR(1D)) 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.