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Published on: February 22, 2013
Effect of high-dose intravenous eletriptan on coronary artery diameter
J A Goldstein1, K D Massey, S Kirby
1William Beaumont Hospital, Royal Oak, MI 48073, USA. jgoldstein@beaumont.edu
Insights
High doses of eletriptan showed similar coronary vasoconstriction to sumatriptan, confirming eletriptan
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Migraine treatments, like triptans, can cause coronary vasoconstriction.
- Eletriptan is a newer triptan medication for migraines.
Purpose of the Study:
- To compare the coronary vasoconstrictive effects of high-dose intravenous eletriptan with standard-dose subcutaneous sumatriptan.
- To assess the cardiovascular safety margin of eletriptan.
Main Methods:
- A randomized controlled trial involving patients without significant coronary artery disease.
- Patients received high-dose intravenous eletriptan (n=24), standard-dose sumatriptan (n=18), or placebo (n=18).
- Serial angiograms were used to measure changes in coronary artery diameter.
Main Results:
- Eletriptan (mean change -22%) and sumatriptan (mean change -19%) demonstrated equivalent coronary vasoconstriction.
- Placebo also showed a modest change (-16%).
- No patients experienced clinically significant vasoconstriction.
Conclusions:
- High-dose eletriptan has a comparable cardiovascular safety profile to standard-dose sumatriptan regarding coronary vasoconstriction.
- Eletriptan exhibits a broad cardiovascular safety margin at therapeutic doses.
Abstract:
The goal of this study was to evaluate the coronary vasoconstrictive effects of high doses of eletriptan compared with a standard dose of sumatriptan. Patients with no clinically significant coronary artery disease were randomized to receive high-dose intravenous eletriptan (n = 24) vs a standard dose of sumatriptan (n = 18; 6 mg subcutaneously) vs placebo (n = 18). Serial angiograms were obtained. The primary non-inferiority analysis found equivalence between the mean maximum change in left anterior descending coronary artery diameter for eletriptan, -22%[95% confidence interval (CI) -26, -19], and sumatriptan, -19% (95% CI -22, -16). The change due to placebo was -16% (95% CI -20, -12). No individual cases of clinically significant vasoconstriction were observed. The results confirm that eletriptan has a broad cardiovascular safety margin, with plasma concentrations comparable to three to five times the Cmax of an oral 80-mg dose associated with modest vasoconstriction equivalent to standard therapeutic doses of sumatriptan.
