 |
|
Editor's Comment
Marjorie A. Bowman, MD, MPA
Arch Fam Med. 2000;9:758.
This is a "real world" article—what happens when a patient takes a new medicine, specifically naratriptan, for migraine headaches?
Studies of new medicines are typically completed in a substantially controlled environment, often with patients who have few other problems, and who are willing to be compliant (perhaps because they are paid to complete the study). The studies are usually short in duration. Efficacy is often defined as a statistically significant improvement of some modest amount, say 25%, which means 75% of patients did not get improvement. Most drug studies are funded by pharmaceutical companies, and the Food and Drug Administration approves new drugs based on such studies.
This method of obtaining information often leaves many gaps between the studies (published and unpublished) and what appears to happen with our patients. Frequently, drugs underperform in comparison with the apparent hype. Patients often want to try them after seeing a direct-to-consumer advertisement, but disappointment may follow. In addition, the drugs may be more expensive than their competitors already on the market.
The present study also is funded by a drug company, and is short-term. So how is it different and worthwhile? First, the environment was family practice offices and there were fewer entry criteria than for most studies, making it more "real world." Second, patients were not paid, but did receive the medication free of charge. And third, patient satisfaction was a primary outcome.
When triptans became available for the treatment of migraine headaches, there was a widespread belief that they would be the major treatment for migraines (note the authors' use of the phrase "revolutionized migraine therapy"). Does this article verify such optimism? My answer is that some optimism is warranted, but the therapy frequently is still not 100% satisfactory for many patients.
More than half of the patients in Powers et al's study had previously received a "triptan," but none were using the triptan as their primary migraine medicine. The expense of the medication was a drawback for some patients; the need for a prescription was another (many took over-the-counter medications). This makes the numbers who were "satisfied" or "very satisfied" with the naratriptan (63%) potentially surprising. Of those who were satisfied with their current therapy, more than half preferred naratriptan therapy (56%). Thus, some level of optimism is warranted.
However, despite good levels of satisfaction, only 35% were "very satisfied" even with the naratriptan. Thus, the authors' findings show that naratriptan could be well liked by some patients, and preferred by some who had been satisfied with their previous migraine medication regimen. Their results also show that offering another medication may improve the response rate for patients, ie, many migraineurs are continuing to suffer unnecessarily. This suggests that we need to pay more attention to patient's level of satisfaction with therapy and attempt more medication trials for our patients with migraine headaches.
RELATED ARTICLE
Evaluation of Migraineurs' Preferences for Naratriptan Over Conventional First-Line Agents
Charles Powers, Simon Szeto, Dennis Pangtay, Thaddeus Bort, Mark Cervi, and Roger Cady
Arch Fam Med. 2000;9(8):753-757.
ABSTRACT
| FULL TEXT
|
