Summary of findings 3. Should triptans be used to treat adolescents with migraine?
| Triptans compared with placebo in adolescents with migraine | ||||||
| Patient or population: acute treatment of migraine in adolescents Setting: ambulatory Intervention: Triptans Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effectsa (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Response with placebo | Response with Triptans | |||||
| Pain freedom at 2 h | Study population | RR 1.32 (1.19 to 1.47) | 6761 (21 RCTs) | ⨁⨁⨁◯b,c MODERATE | Includes almotriptan (1 study), eletriptan (1 study), naratriptan (1 study), rizatriptan (4 studies), sumatriptan (10 studies), and zolmitriptan (4 studies) | |
| 230 per 1000 | 303 per 1000 (273 to 338) | |||||
| Adverse events | 184 per 1000 | 24 per 1000 (15 to 33) |
RD 0.13 (0.08 to 0.18) |
7876 (21 RCTs) |
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GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. CI: confidence interval; RR: risk ratio; RD: risk difference. | ||||||
aThe response in the intervention group (and its 95% confidence interval) is based on the assumed response in the comparison group and the relative effect of the intervention (and its 95% CI). bSerious inconsistency was observed in the effect estimates. All of the triptans with only 1 study were not statistically superior to placebo (i.e. almotriptan, eletriptan, naratriptan) in producing pain freedom while the three triptans with 2 or more studies (i.e. rizatriptan, sumatriptan, and zolmitriptan) were statistically significant with a higher magnitude of effect. In the subgroup analysis of the individual triptan groups through, the subgroup differences were not statistically significant (P = 0.45).
cHigh (⨁⨁⨁⨁) = further research is very unlikely to change our confidence in the estimate of effect; Moderate (⨁⨁⨁◯) = further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; Low (⨁⨁◯◯) = further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; Very Low (⨁◯◯◯) = any estimate of effect is very uncertain.