Triptan Use and Discontinuation: Results From the MAST Study
Migraine continues to be associated with significant unmet acute treatment need.
Neurology Reviews. 2018 August;26(8):30
SAN FRANCISCO—Although triptans are considered the gold standard for acute migraine therapy, only 37% of migraineurs had ever used a triptan and just 15.9% were current triptan users, according to the results of a study presented at the 60th Annual Scientific Meeting of the American Headache Society. Aftab Alam, MBBS, MBA, from Medical Affairs at Dr. Reddy’s Laboratories in Princeton, New Jersey, and colleagues from the Migraine in America Symptoms and Treatment (MAST) study determined that while oral treatment was the most common route of administration, only 11.5% of their total sample (31.1% of ever triptan users and 40.4% of current triptan users) had ever used a non-oral formulation.
The MAST Study collected detailed information regarding patterns of medication use in a sample of patients with migraine. The objectives of the analysis were to understand past and current usage patterns for triptans by route of administration and the rates and reasons for discontinuation.
Study respondents were recruited from a nationwide online research panel. Stratified random sampling identified a representative cohort of individuals 18 and older. A validated migraine symptom screen based on modified ICHD-3 beta criteria identified those with migraine. Study inclusion required an average of at least one headache day per month over the previous three months. Qualified respondents provided sociodemographic data (age, gender, and race) as well as patterns of past and current medication use. For past triptan users, Dr. Alam and his MAST study collaborators assessed reasons for discontinuation from a pre-coded list of side effects and triptan sensation symptoms. Other responses were allowed and coded. The researchers examined descriptive results for each route of administration, but “the groups are not mutually exclusive,” Dr. Alam noted.
Triptan Usage Results
Among 15,133 respondents with migraine, the mean age was 43.1; 73% were women, and 81% were Caucasian. Median monthly headache frequency was 3.3 days per month. A total of 5,596 (37%) had ever used a triptan. Among this subgroup, 81.8% had used oral, 21.3% had used a nasal spray, and 19.0% had used injectable forms; 22.2% had used more than one route of administration. Among current triptan users (2,421, 15.9%), 84.7% use oral, 16.5% use nasal spray, and 8.1% use injectable; 9.3% currently use more than one route of administration. Discontinuation rates were highest for injectable triptans (81.5%), followed by nasal sprays (66.5%) and oral medications (55.2%).
Reasons for Discontinuation
The most common reason for discontinuation was perceived lack of efficacy (38.4% oral, 39.8% nasal spray, 25.7% injectable), followed by side effects (22.8% oral, 17% nasal spray, 20.6% injectable). The most commonly reported side effects were dizziness (37.4% oral, 29.4% nasal spray, 33.5% injectable) followed by nausea (30.7% oral, 32.4% nasal spray, 24.6% injectable) and fatigue (26.2% oral, 24.3% nasal spray, 21.2% injectable). One or more triptan sensation symptom was reported among 60.3% of injection users, 46.5% of oral users, and 39.7% of nasal spray users.
—Glenn S. Williams
Wells RE, Markowitz SY, Baron EP, et al. Identifying factors underlying discontinuation of triptans. Headache. 2014;54(2):278-289.