Study Sheds Light on Reasons Behind Low Triptan Adherence

The results of a 25-year study unveiled a low adherence to triptans medications for migraine treatment “likely due to disappointing efficacy and/or unpleasant side effects rather than economic considerations,” according to study investigators.

“Triptan success continues to be hindered by poor implementation of clinical guidelines and high rates of treatment discontinuance,” wrote study author Olafur B. Davidsson with the department of neurology at the Danish Headache Center, Copenhagen University Hospital in Glostrup, Denmark, in Sage Journals.¹

Davidsson and colleagues set out to discover the efficacy of triptans as the main acute treatment strategy for migraines to better inform clinical decision-making.

They conducted a nationwide register-based cohort study based on all Danish residents with access to public health care between January 1994 and October 2019. They also summarized informative trends of all purchases of triptans in Denmark using the complete purchase records of sumatriptan, naratriptan, zolmitriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan during the same time period.

Over a 25-year period, triptan use increased from 345 to 945 defined daily doses (DDD) per 1000 inhabitants per year and the yearly prevalence of triptan use increased from 5.17 to 14.57 per 1000 inhabitants.

Between 2014 and 2019, 12.3% of the Danish migraine population purchased a triptan. However, following their initial purchase, 43% of patients had not repurchased triptans within 5 years.

Around 10% of patients indicating triptan discontinuation tried more than 1 triptan. The prevalence of triptan overuse — purchasing at least 20 DDDs of triptans per month for 3 consecutive months — increased in parallel with the prevalence of triptan use, prevalent in 56 of every 1000 triptan users annually.

Related: The Pharmacist’s Role in Counseling Patients on Migraine Treatments

Pharmacists can play a role in improving patient adherence to their migraine treatment regimens. Counseling on the proper use of triptan therapy, along with potential adverse effects, can improve the likelihood that patients will see success with their treatment. And for patients who do not experience a desired response to therapy, pharmacists can determine when it may be appropriate to move on and try a different avenue of treatment.

Reference:

1. Davidsson OB, Olofsson IA, Kogelman L JA, et al. Twenty-five years of triptans - a nationwide population study. Sage Journals. February 14, 2021. https://doi.org/10.1177/0333102421991809