Inadequate use of Migraine Specific Medicines, Largest Ever Migraine Survey Shows

Main Category: Headache / Migraine
Article Date: 07 Sep 2004 - 11:00 PDT

email to a friend   printer friendly   opinions  

The world's biggest international survey of migraine patients shows clearly that, despite the availability of effective, migraine-specific medicines, patients are still not receiving optimal care for this highly debilitating neurological condition.

According to the results of the fourth phase of the MAZE* (Migraine and Zolmitripan Evaluation) survey presented at the European Federation of Neurological Societies meeting today, the majority of migraine sufferers have tried and failed on several analgesics and anti-emetics before finally seeking medical help. Yet when migraine patients do consult, many doctors continue prescribing these non-specific treatments, despite the widespread availability of effective triptans such as 'Zomig' (zolmitriptan).

"The MAZE survey started in 2000. It is now in its fourth phase and is ongoing," says the MAZE Medical Steering Committee Chairwoman Dr Anne MacGregor from The City of London Migraine Clinic, UK. "The results have helped us to increase our knowledge of this common, yet often under recognised and under treated disorder."

MAZE IV

MAZE IV is an on-going, Internet-based survey of migraine patients, as defined by the International Headache Society diagnostic criteria or by their doctor's diagnosis. Data from a total of 3,072 UK migraine patients have been analysed to date.1

Patients were asked how they treated their latest migraine attack. Most patients (89%) used medication; one half (52%) used an analgesic and anti-emetic and only one fifth (20%) used a triptan. Of patients using medication, 72% required another dose of medication or treatment, but this was significantly lower in patients who initially used a triptan. In addition, among patients receiving a prescription medication, triptan users were significantly more satisfied with treatment than non-triptan users. The main drivers for choosing a triptan to treat a migraine attack were the need for fast control of symptoms (71%) and the severity of the attack (70%).

Similar findings were found in an ongoing French study, FRAMIG**. This study showed that 91% of all migraine sufferers self-medicate and that overuse of analgesics is very frequent. A quarter of French migraine patients have never seen a doctor about their migraine and 59% have consulted a doctor, but have no ongoing medical follow up.2 Only 7.6% of French migraine sufferers were found to take a triptan to treat their migraine attacks. Not surprisingly, in the majority of cases, symptom relief was judged to be insufficient.3

In other countries, the situation is not much better. MAZE I, carried out in the UK, Germany, France, Italy and the US in 2000, showed that approximately half of those suffering from migraine do not consult a doctor despite a high level of pain and disruption of their lives. On average, only 1 in 10 of those seeking medical help received a triptan with the situation being better in the US and worse in Europe.4

"Triptans should be first-line therapy for migraine attacks and should not be reserved for the 'big headache' only", explains Dr Andy Dowson, Director of Headache Services, Kings College Hospital, London. "The MAZE survey has shown that patients are not satisfied with their current care. Physicians and patients should develop a treatment plan based on patient needs, preferences and treatment experience. In addition, physicians should also educate patients about migraine-specific acute treatments and the specific benefits of triptans."

'Zomig' Nasal Spray

MAZE IV revealed that speed of action was a key driver of patient preference for migraine treatment. Data presented at the EFNS congress show that 'Zomig' Nasal Spray has the earliest onset of action for a patient-friendly (non-injectable) triptan.

In phase I of the randomised, double blind, placebo-controlled REALIZE study (n=912), 'Zomig' Nasal Spray demonstrated a significant (p 0.01) headache response from 10 minutes, with a 65% headache response at two hours. In addition, significantly more 'Zomig' Nasal Spray patients experienced total symptom relief (no headache, no nausea, no photophobia or phonophobia) from 30 minutes onwards compared to placebo (p 0.05).5

Phase II of REALIZE (n=851) examined patient satisfaction with the new formulation after treating three migraine attacks. Over three-quarters (76.7%) of patients said they were satisfied or very satisfied with 'Zomig' Nasal Spray overall. In addition, 76.9% were satisfied in terms of speed of relief, and 92.8% were satisfied in terms of ease of use. The majority of patients preferred the new nasal spray to existing treatment (58.5%).5

"Our study has shown that 'Zomig' Nasal Spray achieves high levels of patient satisfaction and is very well tolerated", says Marek Gawel MD, one of the study investigators from the Department of Neurology, University of Toronto, Canada. "Speed of relief, convenience, ease of use and reliability are the major reasons that patients are very satisfied with this new formulation. Patients prefer 'Zomig' Nasal Spray over previous therapies and are willing to continue using this new treatment."

Pharmacokinetic data presented at EFNS show that 'Zomig' is rapidly absorbed intranasally and present in the plasma at two minutes and in the CNS at five minutes post dose. This correlates well with the very fast onset of action seen after 10 minutes, the early pain-free time point (15 minutes) and high efficacy of 'Zomig' Nasal Spray when used to treat acute migraine attacks.6 The intranasal uptake of Zomig is advantageous for patients requiring rapid relief and those with nausea, vomiting, or those who fear needles for self-injection. In addition, 'Zomig' Nasal Spray has a good tolerability profile7 and is supplied in an easy-to-use, convenient device. The formulation was first launched in Sweden in January 2002 and is now widely available in Europe and North America.

AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the top five pharmaceutical companies in the world with healthcare sales of over $18.8 billion and leading positions in sales of gastrointestinal, oncology, cardiovascular, neuroscience and respiratory products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global and European) as well as the FTSE4Good Index.

In Neuroscience, AstraZeneca is dedicated to providing medicines that have the potential to change patients' lives. The company already markets several products including Seroquel®, the fastest growing major atypical agent, and 'Zomig'. The Neuroscience pipeline includes leading approaches for the treatment of depression and anxiety, overactive bladder,

dementia, stroke, and pain control. Contact information

For further information, please contact:

Olivia Garbutt,
CPR Worldwide: +44 (0) 207 395 7100
On site at EFNS: +44 7779 094 944

'Zomig', 'Zomig' Nasal Spray and 'Zomig Rapimelt' are trademarks of the AstraZeneca Group of companies.

Notes for editors:

*MAZE research has been carried out by an independent market research company. The survey is funded by an unrestricted educational grant provided by AstraZeneca. MAZE IV started as a UK pilot and will be continued in Canada. The four phases of MAZE have provided data on the prevalence of migraine (MAZE I), current experiences and treatment of migraine patients (MAZE II), impact of migraine on quality of life and families (MAZE III) and a 'snap shot' of what patients are actually doing in practice to treat their migraine (MAZE IV).

**FRAMIG, the first epidemiological survey performed in the general population using the second edition of the IHS classification, is a French survey carried out by an independent market research company. The survey is funded by an unrestricted educational grant provided by AstraZeneca France. FRAMIG1 and FRAMIG2 have been completed. FRAMIG3 comprises four parallel surveys (general practitioners, pharmacists, migraineurs and migraineurs families and carers) and is ongoing.

References 1 MacGregor E A, Brandes J, Eikermann A, Giammarco R. Patient strategies for the management of migraine: interim results from an on-line market research study (MAZE study phase IV) -- presented at the European Federation of Neurology Societies Congress, Paris, 4 - 7 September 2004.06.15

2. Lucas C, Lanteri-Minet M et al. Lettre du Neurologue 2000; IV (suppl 5):14-6.

3. Lucas C, Lanteri-Minet M et al. Douleurs 2001;2:240-3.

4. MacGregor et al. Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey. Headache 2003;43(1):19-26.

5. Gawel M, Aschoff J, May A, Charlesworth B R on behalf of the REALIZE study group. Efficacy, onset of action and patient satisfaction with zolmitriptan nasal spray: phases I and II of the REALIZE study - presented at the European Federation of Neurology Societies Congress, Paris, 4 - 7 September 2004.

6. Rapoport A, Uemura N, Wall A, Gawel M, Dodick D. Zolmitriptan nasal spray demonstrates rapid nasal absorption (2 minutes), early CNS uptake (5 minutes) and early onset of efficacy (10 minutes) in the acute treatment of migraine -- presented at the European Federation of Neurology Societies Congress, Paris, 4 - 7 September 2004.

7. Dowson AJ, Boes-Hansen S, Farkkila AM. Zolmitriptan nasal spray is fast-acting and highly effective in the acute treatment of migraine. J Neurol 2000;7(suppl 3):82.

• Additional
• References
• Citations