A triptan too far?
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London UK
- Dr Peter J Goadsby, Institute of Neurology, Queen Square, London WC1N 3BG, UK. Fax 0044 171 813 0349; email
The past decade has seen a remarkable transition in neurological practice which has been driven in considerable measure by therapeutic developments. Clinical neurology, once driven primarily by the diagnostic process, is increasingly becoming a therapeutic speciality. Headache, so often the ugly sister, ubiquitous, ill-understood, and ever bothersome in the clinic, has given up some of its secrets to enrich our practice and improve the life of our patients.1 For headache treatment the 1990s will be the decade of the triptans: 3,5 substituted indole, selective serotonin (5HT1B/1D) agonists, sumatriptan and its relatives. As the second generation of the triptans emerge this editorial attempts to provide a summary of the new compounds and formulations which will be a basis for defining the new medicines’ place in clinical practice. I will start with the question of whether there is a need for newer treatments, outline the methods used for the clinical assessments, and conclude by suggesting some of the situations in which any or some of the new drugs have an advantage.
To be practical I will consider the triptans that are actually available now in many parts of the world, particularly in Europe. As decisions to use these compounds are now faced daily by both neurologists and general practitioners this review will focus on sumatriptan, naratriptan, and zolmitriptan. Other compounds, including rizatriptan,2 which has completed phase III development and which should appear next, and eletriptan,3 which is currently in late phase III, as well as drugs less well known and still in development, such as VML2514 and almotriptan,5 will not be considered because they are not currently available. The principles used to review the available compounds could be applied to newer compounds when they become available.
Do we need new treatments for acute migraine attacks?
Before the introduction of sumatriptan in the early part of …