Nasal Sumatriptan Superior for Migraine Pain Relief
Nasal administration was found to be superior to oral treatment for migraine.
Nasal administration of sumatriptan powder (AVP-825) in patients with migraine results in quicker reductions in pain intensity and migraine-related disability compared with oral sumatriptan, according to a study published in Headache.
Researchers analyzed patient data from the COMPASS study on patients with migraine (n=259). In this study, subjects were given either AVP-825 with placebo tablets or placebo plus 100 mg oral sumatriptan tablets within 1 hour of migraine onset. Following the first 12-week treatment period, participants switched treatment sequences and resumed therapy for an additional 12 weeks.
The patient sample was comprised of primarily women (84.6%) with a mean age of 40. In all patients in this cohort, the investigators observed significant differences in migraine pain intensity as well as migraine-related disability. When treated with AVP-825, patients had faster migraine pain reduction over the first 30 minutes and faster reduction in migraine-related disability over the first 45 minutes when compared with oral sumatriptan.
An odds ratio (OR) of less than 1 indicated reduced pain/migraine-related disability in the AVP-825 treatment group. The model-based odds ratios (ORs) varied from 0.38 to 0.76 for pain and 0.37 to 0.65 for disability when comparing AVP-825 to oral sumatriptan. In addition, fixed effects results demonstrated treatment-by-time interactions, indicating that pain reduction over time differed in patients treated with AVP-825 vs oral sumatriptan (P <.0001).
Since the COMPASS study did not compare the treatment group with a placebo-only arm, the investigators believe their findings may be limited. According to the researchers, administration of a placebo “might attenuate participation even in the arms where active treatment is offered.”
Lipton RB, McGinley JS, Shulman KJ, Wirth RJ, Buse DC. Faster improvement in migraine pain intensity and migraine-related disability at early time points with AVP-825 (sumatriptan nasal powder delivery system) versus oral sumatriptan: a comparative randomized clinical trial across multiple attacks from the COMPASS study [published online September 7, 2017]. Headache. doi:10.1111/head.13165