no ‘best’ drug for migraine yet

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6 No 'best'drug for migraine yet Although doctors' decisions about prophylactic migraine therapy are generally based on scientific data about efficacy, the poor quality of these data means that decisions remain largely empirical. This is the conclusion of US-based researchers who examined the scientific rigour of published trials of prophylactic migraine drugs, assessed their cost, and investigated any relationships between medication use, scientific rigour and cost. A survey of 100 neurologists and 96 primary-care physicians revealed the weighted average percent usage of each drug. Efficacy infonnation poor Doctors' choice of migraine prophylaxis was strongly correlated with scientific proof of drug efficacy, but was not correlated with drug cost. However, the efficacy advantage over placebo for the 3 most commonly chosen migraine prophylactic drugs (propranolol, amitriptyline and verapamil) has not exceeded 50% in trials, except for one poorly conducted study of propranolol. The quality of the trials investigating migraine prophylaxis has generally been poor. P-Blockers, tricyclic antidepressants and calcium antagonists were prescribed by 38, 30 and 15% of neurologists, respectively, as first-line migraine prophylaxis. A similar pattern of prescribing emerged among primary-care physicians (41, 18 and 16%, respectively). Ramadan NM. Schultz LL. Gilkey S1. Migraine prophylactic drugs: proof of efficacy. utilization and cost. Cephalalgia 17: 73-80. Apr 1997 , oom,,,, PharmacoEconomics & Outcomes News 17 May 1997 No. 112 1173-5503l97/0112-0006/$Ol .00 C Adislnternational Limited 1997. All rights reserved

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Page 1: No ‘best’ drug for migraine yet

6

No 'best'drug for migraine yet Although doctors' decisions about prophylactic

migraine therapy are generally based on scientific data about efficacy, the poor quality of these data means that decisions remain largely empirical.

This is the conclusion of US-based researchers who examined the scientific rigour of published trials of prophylactic migraine drugs, assessed their cost, and investigated any relationships between medication use, scientific rigour and cost. A survey of 100 neurologists and 96 primary-care physicians revealed the weighted average percent usage of each drug.

Efficacy infonnation poor Doctors' choice of migraine prophylaxis was strongly

correlated with scientific proof of drug efficacy, but was not correlated with drug cost. However, the efficacy advantage over placebo for the 3 most commonly chosen migraine prophylactic drugs (propranolol, amitriptyline and verapamil) has not exceeded 50% in trials, except for one poorly conducted study of propranolol. The quality of the trials investigating migraine prophylaxis has generally been poor.

P-Blockers, tricyclic antidepressants and calcium antagonists were prescribed by 38, 30 and 15% of neurologists, respectively, as first-line migraine prophylaxis. A similar pattern of prescribing emerged among primary-care physicians (41, 18 and 16%, respectively). Ramadan NM. Schultz LL. Gilkey S1. Migraine prophylactic drugs: proof of efficacy. utilization and cost. Cephalalgia 17: 73-80. Apr 1997 ,oom,,,,

PharmacoEconomics & Outcomes News 17 May 1997 No. 112 1173-5503l97/0112-0006/$Ol .00C Adislnternational Limited 1997. All rights reserved