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'Shocking' percentage of patients on triptans despite risks.


SAN DIEGO - Triptans are routinely prescribed to migraine patients who have a history of cardiovascular disease, according to evidence from a large medical claims database study.

Serotonin (5-HT) receptor agonists are among the most commonly prescribed medications for migraine patients, but are contraindicated in patients with a history, signs, or symptoms of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes; any other underlying cardiovascular disease; or uncontrolled hypertension, according to package inserts.

Daisy S. Ng-Mak, Ph.D., of Merck Sharp & Dohme and her colleagues randomly selected 10 representative health plans from MedAssurant Inc.'s MOR [E.sup.2] (Medical Outcomes for Research on Economics and Effectiveness) registry, which contains records from 2.5 million people. They found that 8% of 121,286 migraine patients had a cardiovascular contraindication, such as a history of myocardial infarction or stroke or documented prescriptions for cardiovascular disease. Among those patients, 22% had received a prescription for a triptan in 2009, the authors reported at the meeting. The MedAssurant MORE2 registry includes claims data on patients aged 18-64.

Dr. Ng-Mak and her coauthors identified migraine patients through chart diagnoses, prescription claims, or treatment of at least two headaches at least a week apart. They similarly found cardiovascular contraindications by either diagnosis or prescription claim data. Among patients aged 18-49 years with such a cardiovascular contraindication, 24% received a triptan prescription.

"Especially ... concerning," the authors noted, was the fact that 21% of older migraine patients with cardiac contraindications at the time of the study had received a triptan prescription.

"We really don't know why we saw this high percentage - a shocking percentage - of patients with cardiac contraindications [who were] receiving triptans," Dr. Ng-Mak said in an interview after the meeting.

Dr. Juline Bryson, a neurologist and headache specialist at St. Luke's/Roosevelt Medical Center in New York City, said "overfamiliarity" may be to blame.

In the 20 years since the introduction of sumatriptan, the drug class has greatly expanded and has been widely accepted as efficacious therapy for migraine, she said.

"We may be getting so comfortable with prescribing triptans these days that we almost think of them like Aleve or Advil," said Dr. Bryson, who was not affiliated with the database study.

MedAssurant's MOR [E.sup.2] registry was sponsored by Merck Sharp & Dohme. The AMPP study was funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologies, with ad ditional support provided by Allergan Pharmaceuticals, NuPathe Inc., mid Merck Sharp &C Dohme. Some of the AMPP investigators, including Dr. Buse, have received research support from Allergan and NuPathe.

The authors found that of the migraine patients who had a cardiovascular contraindication, 22% had received a prescription for a triptan in 2009.
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Author:Bates, Betsy
Publication:Clinical Psychiatry News
Date:Nov 1, 2011
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