A Sumatriptan Iontophoretic Transdermal System for the Acute Treatment of Migraine

• Published in: Headache 2012-10, Vol.52 (9), p.1402-1410
• Main Authors: Goldstein, Jerome, Smith, Timothy R., Pugach, Neil, Griesser, Jim, Sebree, Terri, Pierce, Mark
• Format: Article
• Language: English
• Subjects: Adult; Analgesics - administration & dosage; Analgesics - therapeutic use; Biological and medical sciences; Cardiovascular system; Clinical trials; Double-Blind Method; Female; Gastrointestinal tract; Headache; Headaches; Humans; Iontophoresis; Male; Medical sciences; Migraine; Migraine Disorders - drug therapy; Nausea; Neurology; Pain; Pharmacology. Drug treatments; sumatriptan; Sumatriptan - administration & dosage; Sumatriptan - therapeutic use; Transdermal Patch; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators; Vomiting
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2012.02198.x

Objective.— Gastrointestinal symptoms, such as nausea and vomiting, occur almost universally at one time or another in patients during a migraine attack. One third of patients who experience migraine‐related nausea report that this symptom interferes with their ability to take oral medications. The sumatriptan iontophoretic transdermal system (NuPathe Inc., Conshohocken, PA, USA) uses proprietary technology to circumvent the gastrointestinal tract while delivering triptan therapy. This phase III randomized, double‐blind, placebo‐controlled trial evaluated the efficacy and tolerability of this system for the acute treatment of migraine. Methods.— Patients were randomized to treat a single moderate‐to‐severe migraine attack with the sumatriptan iontophoretic transdermal system or placebo. The primary end point was the proportion of patients who were headache pain‐free 2 hours after patch activation. Other end points included the proportions of patients who reported headache pain relief, and freedom from nausea, photophobia, and phonophobia; rescue medication use; and tolerability. Results.— Four hundred sixty‐nine patients were treated. Significantly more patients treated with the sumatriptan iontophoretic transdermal system compared with placebo experienced freedom from headache pain, nausea, photophobia, and phonophobia 2 hours after patch activation, experienced rapid and sustained headache pain relief, and used less rescue medication. Treatment‐emergent adverse events were reported by 50% and 44% of patients treated with the sumatriptan iontophoretic transdermal system and placebo, respectively. Most events were transient mild‐to‐moderate application‐site reactions. Conclusions.— The sumatriptan iontophoretic transdermal system is effective and well tolerated, and may be particularly useful in patients with migraine‐related gastrointestinal symptoms such as nausea.