- Letter to the Editor
- Open Access
Subcutaneous sumatriptan: results of a peculiar, unpublished, comparative, double-blind, randomised, and controlled trial
© The Author(s) 2011
- Received: 24 January 2011
- Accepted: 2 February 2011
- Published: 1 March 2011
- Headache Relief
To the Editor,
Aspirin plus metoclopramide, an antiemetic and prokinetic drug, for acute migraine treatment was introduced by Marcia Wilkinson at The City of London Migraine Clinic  and until the advent of sumatriptan, it was in several countries the standard treatment for migraine, see . Sumatriptan, subcutaneous 6 mg and oral 100 mg, was introduced in 1991 . Subcutaneous sumatriptan 6 mg resulted in headache relief (HR) (a decrease of headache from moderate or severe to none or mild) in 70–72% after 1 h [4, 5] and 86% after 2 h .Oral sumatriptan 100 mg (56% HR) was not superior to the oral combination of aspirin 1,000 mg and metoclopramide (ASP + M)10 mg (45%) in the first attack treated, but sumatriptan was better than the combination in the second and third attack .
From 1993 to 1994, a randomised, controlled trial (RCT) was performed in France. It had the title: “A randomised, multicentre, double-blind, double-dummy, parallel-group study to compare the efficacy and safety of subcutaneous sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine” .
Headache relief (HR) and therapeutic gain (percentage HR after subcutaneous sumatriptan 6 mg minus percentage HR after effervescent aspirin 1,000 mg plus metoclopramide) for the first-treated migraine attack
Sumatriptan (n = 122)
ASP + M (n = 125)
Headache relief after 30 min
Therapeutic gain 26% (95% CI 14–37%)
Headache relief after 60 min
Therapeutic gain 26% (95% CI 14–38%)
Headache relief after 120 min
Therapeutic gain 22% (95% CI 11–32%)
The rationale for doing this RCT remains obscure. Why should an injection of an antimigraine drug (the optimal route of administration) be compared with an oral form of another antimigraine drug (a suboptimal form because of slower absorption)? The most likely reason is that this RCT was done solely for registration purposes in France. We don’t know whether it was done at the request of the French health authorities. Any way, this RCT, even if based only on the summary, was of good quality and the RCT remains unpublished 17 years later. Publication is an obligation of the clinical investigators  and this RCT should have been published many years ago.
Conflict of interest
This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author(s) and source are credited.
- Wilkinson M (1976) Editorial: the treatment of acute migraine attacks. Headache 15:291–292, 1245412, 10.1111/j.1526-4610.1976.hed1504291.x, 1:STN:280:DyaE28%2FpsVCrtw%3D%3DView ArticlePubMedGoogle Scholar
- Olesen J, Aebelholt A, Veilis B (1979) The Copenhagen acute headache clinic: organization, patient material and treatment results. Headache 19:223–227, 36364, 10.1111/j.1526-4610.1979.hed1904223.x, 1:STN:280:DyaE1M7ptlOgtQ%3D%3DView ArticlePubMedGoogle Scholar
- Humhrey PP (2008) The discovery and development of the triptans: a major therapeutic breakthrough. Headache 48:685–687, 10.1111/j.1526-4610.2008.01097.xView ArticleGoogle Scholar
- Subcutaneous Sumatriptan International Study Group (1991) Treatment of migraine attacks with sumatriptan. N Engl J Med 325:316–321, 10.1056/NEJM199108013250504View ArticleGoogle Scholar
- Cady RK, Wendt JK, Kirchner JR, Sargent JD, Rothrock JF, Skaggs H Jr (1991) Treatment of acute migraine with subcutaneous sumatriptan. JAMA 265:2831–2835, 1851894, 10.1001/jama.265.21.2831, 1:STN:280:DyaK3M3jsl2ntw%3D%3DView ArticlePubMedGoogle Scholar
- The Oral Sumatriptan and Aspirin plus Metoclopramide Comparative Study Group (1992) A study to compare oral sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine. Eur Neurol 32:177–184, 10.1159/000116818View ArticleGoogle Scholar
- Study no.: S2BL99. A randomised, multicentre, double-blind, double-dummy, parallel-group study to compare the efficacy and safety of subcutaneous sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine. www.gsk-clinicalstudyregister.com. Assessed October 2010
- Chabriat H, Joire JE, Danchot J, Grippon P, Bousser MG (1994) Combined oral lysine acetylsalicylate and metoclopramide in the acute treatment of migraine: a multicentre double-blind placebo-controlled study. Cephalalgia 14:297–300, 7954760, 10.1046/j.1468-2982.1994.1404297.x, 1:STN:280:DyaK2M%2Fkt1KrtA%3D%3DView ArticlePubMedGoogle Scholar
- Tfelt-Hansen P, Henry P, Mulder K, Scheldewaert RG, Schoenen J, Chazot G (1995) The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet 346:923–926, 7564725, 10.1016/S0140-6736(95)91554-0, 1:CAS:528:DyaK2MXpsFahsb0%3DView ArticlePubMedGoogle Scholar
- Ethics Subcommittee of the International Headache Society (1998) Ethical issues in headache research and management. Cephalalgia 18:505–529, 10.1046/j.1468-2982.1998.1807505.xView ArticleGoogle Scholar