"There are migraine patients who usually have a poor response to any migraine treatment. You can identify them," said lead investigator Hans-Christoph Diener, MD, PhD, professor, department of neurology, University of Essen, Essen, Germany. "For example, 1 parameter is people who always progress extremely quickly from no headache to severe headache, and they usually have a poor response to treatment."

Dr. Diener and colleagues identified the predictors for poor response and conducted a retrospective evaluation of patients who had predictors of either poor or good responses using a database of all eletriptan trials. Nonresponders were identified through multivariate analysis and descriptive statistics of response rates in 10 randomized, double-blind, placebo-controlled trials of eletriptan in migraine patients.

Participants in all the studies were instructed to take the active drug when their headache was moderate to severe in intensity after the aura phase had ended.

Results show that significantly more patients reported a response to treatment at 2 hours after taking eletriptan 40 mg compared with placebo (P < .0001), and significantly more eletriptan-treated patients reported being pain free at 2 hours postdose than in the placebo arm (P < .0001).

"The results showed that all the people with predictors of poor response did respond to eletriptan, but their response, as you would expect, is lower than for those patients who have no risk for poor response," Dr. Diener said. "In terms of numbers, the pain-free response in the poor responders is 24% after 2 hours, compared with 34% in those who usually respond well, and placebo rates are 5% and 5%, [respectively]," Dr. Diener said.

The investigators also found that at 2 hours postadministration a higher proportion of eletriptan treated patients with severe baseline pain achieved a 2-point reduction in pain, according to study criteria, compared with those with moderate pain at baseline. In fact baseline headache intensity was the only factor found to produce a significant effect on response to medication at 2 hours.

Associations were evident between reduction of headache pain and significantly greater functional responses, and the absence of nausea and photo/phonophobia, (P < .0001 for all). Additionally, there was a significant (P < .05) reduction in headache recurrence, which resulted in a significantly higher sustained response in the eletriptan arm, compared with placebo (P < .0001).

"This study shows that this drug works in patients who usually have a poor response to treatment," Dr. Diener said.


[Presentation title: Efficacy of Eletriptan in Migraine Patients at High Risk for Non-Response. Poster F047]

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