Background

The efficacy of triptans as the main acute treatment strategy for migraine headache at the population-wide level needs to be understood to inform clinical decision-making. We summarise key trends in triptan use using more than 25 years of Danish nationwide data.

Methods

We conducted a nationwide register-based cohort study based on all Danish residents with access to public healthcare between 1 January 1994 and 31 October 2019 and summarise informative trends of all purchases of triptans in Denmark in the same period. Complete purchase records of Sumatriptan, Naratriptan, Zolmitriptan, Rizatriptan, Almotriptan, Eletriptan, and Frovatriptan were used.

Findings

Over a 25-year period, triptan use increased from 345 to 945 defined daily doses (DDD) per 1000 inhabitants per year and the yearly prevalence of triptan use increased from 5.17 to 14.57 per 1000 inhabitants. Between 2014 and 2019, 12.3% of the Danish migraine population purchased a triptan. Following their initial purchase, 43% of patients had not repurchased triptans within 5 years. At most, 10% of patients indicating triptan discontinuation tried more than one triptan. The prevalence of triptan overuse, defined as having purchased at least 20 DDDs of triptans per month for 3 consecutive months, increased in parallel with the prevalence of triptan use, prevalent in 56 of every 1000 triptan users every year between 2014 and 2019.

Interpretation

In a cohort with access to free clinical consultations and low medication costs, we observed low rates of triptan adherence, likely due to disappointing efficacy and/or unpleasant side effects rather than economic considerations. Triptan success continues to be hindered by poor implementation of clinical guidelines and high rates of treatment discontinuance.

中文翻译：

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曲坦类药物 25 年——一项全国人口研究

背景

需要了解曲坦类药物作为人群范围内偏头痛的主要急性治疗策略的疗效，以便为临床决策提供信息。我们使用超过 25 年的丹麦全国数据总结了曲坦类药物使用的主要趋势。

方法

我们对 1994 年 1 月 1 日至 2019 年 10 月 31 日期间所有获得公共医疗保健的丹麦居民进行了一项基于登记的全国队列研究，并总结了同期丹麦所有曲坦类药物购买的信息趋势。使用了舒马曲坦、那拉曲坦、佐米曲坦、利扎曲坦、阿莫曲坦、依乐曲坦和弗罗曲坦的完整购买记录。

发现

在 25 年的时间里，曲坦类药物的使用量从每年每 1000 名居民的 345 次增加到 945 次确定日剂量 (DDD)，每年每 1000 名居民中曲坦类的使用率从 5.17 次增加到 14.57 次。2014 年至 2019 年期间，12.3% 的丹麦偏头痛人群购买了曲坦类药物。首次购买后，43% 的患者在 5 年内没有重新购买曲坦类药物。至多 10% 的表明曲坦类药物停用的患者尝试了一种以上的曲坦类药物。曲坦过度使用的流行率，定义为连续 3 个月每月购买至少 20 DDD 的曲坦类药物，与曲坦类药物的使用流行率同时增加，在 2014 年至 2019 年期间，每年每 1000 名曲坦类使用者中有 56 名流行。

解释

在可以获得免费临床咨询和低药物成本的队列中，我们观察到曲坦类药物依从性低，这可能是由于令人失望的疗效和/或令人不快的副作用，而不是经济方面的考虑。曲坦类药物的成功继续受到临床指南执行不力和治疗中断率高的阻碍。