Are Triptans with Enhanced Lipophilicity Used for the Acute Treatment of Migraine Associated with an Increased Consulting Rate for Depressive Illness?
| Autor: | Peter Croft, Martin Frischer, D Millson, Peter J. Goadsby |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Male
medicine.medical_specialty Indoles Migraine Disorders Zolmitriptan Triptans Logistic regression Cohort Studies 03 medical and health sciences 0302 clinical medicine Piperidines Internal medicine Pharmacovigilance medicine Humans 030212 general & internal medicine Referral and Consultation Oxazolidinones Depression (differential diagnoses) Naratriptan Depression Sumatriptan business.industry General Medicine medicine.disease Tryptamines Serotonin Receptor Agonists Migraine Anesthesia Regression Analysis Female Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Cephalalgia. 20:732-737 |
| ISSN: | 1468-2982 0333-1024 |
| DOI: | 10.1111/j.1468-2982.2000.00111.x |
| Popis: | Sumatriptan, the first marketed triptan, acts predominantly as a peripheral 5-HT1B/1D agonist. Recently launched (naratriptan and zolmitriptan) triptans with enhanced lipophilicity (TEL) may theoretically reduce central 5-HT levels, potentially exacerbating depressive illness. The aim of this study was to compare depressive illness patient consulting rates (PCR) between the newer triptans and sumatriptan treated patients. Migraine-diagnosed patients were identified from the West Midlands General Practice Research Database (GPRD). Univariate and logistic regression analyses were used to determine the relationship between age, sex, migraine duration, prior depression, prior and current triptan medication and the current PCR for depression. Of a total patient database of 642 000 patients 21 331 (3.3%) had a diagnosis of migraine. From 1993 to 1997, sumatriptan-treated migraineurs had significantly higher depression PCRs (22.3%) compared with non-triptan users (19.3%), a difference of 6.4% (95% confidence interval (CI) 4.6–8.4%, P < 0.001). In the year (April 1997 to March 1998) following the launch of the TELs, depression PCRs were significantly higher among patients using these compounds compared with sumatriptan-treated patients (5.1%, CI 1.8–12.0%, P < 0.05). However, after taking account of prior depression (odds ratio (OR) 6.45, 95% CI 3.63–11.43), TELs were not significantly associated with depression (OR 0.27, 95% CI 0.03–2.13). Furthermore, rates of newly diagnosed depression after treatment were similar in the two triptan groups (sumatriptan 4.2%; TELs 3.9%). Although, the TELs are being prescribed to patients with higher pre-existing rates of depression, they are not associated with subsequently increased consulting for depressive illness compared with patients taking sumatriptan. This study highlights the potential to use GPRD to test targeted hypotheses exploring pharmacovigilance issues for patients using new medicines. |
| Databáze: | OpenAIRE |
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