Oral rizatriptan versus oral sumatriptan: A direct comparative study in the acute treatment of migraine

Rizatriptan is a potent, oral, 5-HT1B/1D agonist with more rapid absorption and higher bioavailability than oral sumatriptan. it was postulated that this would result in more rapid onset of effect This randomized, double-blind, triple-dummy, parallel-groups study compared rizatriptan 5 mg, rizatriptan 10 mg, sumatriptan 100 mg, and placebo in 1268 outpatients treating a single migraine attack Headache relief rates after rizatriptan 10 mg were consistently higher than sumatriptan at all time points up to 2 hours, with significance at 1 hour (37% versus 28%, P=0.010). All active agents were significantly superior to placebo with regard to headache relief and pain freedom at 2 hours (P less than or equal to 0.001). The primary efficacy endpoint of time time to pain relief through 2 hours demonstrated that, after adjustment for age imbalance, rizatriptan 10 mg had earlier onset than sumatriptan 100 mg (P=0.032; hazard ratio 1.21). Rizatriptan 10 mg was also superior to sumatriptan on pain-free response (P=0.032), reduction in functional disability (P=0.015), and relief of nausea at 2 hours (P=0.010). Significantly fewer drug-related clinical adverse events were reported after rizatriptan 10 mg (33%, P=0.014) compared with sumatriptan 100 mg (41%). We conclude that rizatriptan 10 mg has a rapid onset of action and relieves headache and associated symptoms more effectively than sumatriptan 100 mg.