Patient preference in migraine therapy. A randomized, open-label, crossover clinical trial of acute treatment of migraine with oral almotriptan and rizatriptan.

OBJECTIVE To assess patient preference for almotriptan 12.5 mg vs rizatriptan 10 mg for the acute treatment of migraine. METHODS Randomized, multicenter, open-label, crossover trial in which triptan-naïve patients treated two moderate/severe migraine attacks, the first with one triptan and the second with the other: 183 patients took rizatriptan followed by almotriptan and 189 treated in the reverse order. Patient preference was assessed with a self-administered questionnaire. RESULTS Of those recording a preference (209), 54.5% preferred almotriptan, but statistical significance was not achieved. The main reason for preference for one or the other triptan was efficacy: 43% of patients preferring almotriptan gave faster headache relief as the reason and 34% cited faster return to normal activities. The corresponding values for rizatriptan were 47% and 38%. A significantly greater proportion of those preferring almotriptan cited fewer adverse events (AEs) as the reason. Almotriptan and rizatriptan were of comparable efficacy and both treatments were well tolerated; 9% of patients experienced AEs probably or possibly related to study medication after almotriptan vs 14% after rizatriptan. Almotriptan was associated with a significantly lower incidence of triptan-associated AEs in triptan-naïve patients (8.5% vs 18% with rizatriptan). CONCLUSION Physicians should use information from meta-analyses and preference studies like this one to aid in the selection of a triptan with a high likelihood of providing rapid, sustained relief from pain coupled with an absence of AEs. About 55% of patients recording a preference in this trial preferred almotriptan, perhaps because of its combination of good efficacy and lower incidence of triptan-associated AEs.