Almotriptan in Triptan-Naïve Patients: New Evidence of Benefits

Although triptans represent the standard of care for migraine that is severe, disabling and/or suboptimally responsive to migraine non-specific analgesia, they are often underused in clinical practice. Simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) may provide effective treatment in some patients, but it is an inadequate response to these drugs that drives the therapeutic progression to triptans at the end of the traditional ‘step-care’ approach. However, there are several disadvantages to this approach. It may cause patients to lose confidence in their physician during this hierarchical ‘trial-and-error’ search for optimal treatment when prescribed medications are ineffective, leading them to cease consulting before triptans are tried. It may also result in a protracted time interval of suboptimal treatment, with unnecessary suffering in patients who are triptan candidates. The alternative approach of ‘stratified care’, in which medication is prescribed according to the severity of symptoms, enables triptans to be used earlier in the treatment plan, especially when triptan candidates are given a choice between simple analgesic/NSAID and triptan medication from the start. This raises the question about the efficacy of triptans in triptan-naïve (TN) patients. A recent exploratory post-hoc analysis compared the effect of almotriptan 12.5 mg in TN patients ( n = 342) with that in triptan-experienced patients ( n = 237). Almotriptan was effective in both cohorts with a consistent trend in favour of the efficacy of almotriptan in TN patients, notably for sustained pain freedom (SPF) and SPF plus no adverse events. Moreover, both headache recurrence at 24 h and the use of rescue medication was lower in the TN patients, whereas tolerability was equally good in both cohorts. These findings indicate that TN patients can expect excellent symptom control when they progress from non-specific analgesia to treatment with almotriptan and support the earlier use of triptans in line with the stratified care paradigm.

Overview: The allergic reaction and site-based therapy

The successful management of upper respiratory tract allergy is based on a triad of interdependent approaches that, with rare exceptions, must all be considered in every allergic patient. They consist of allergen avoidance with environmental control measures, pharmacotherapy with use of a step-care approach, and immunotherapy. Environmental control measures should be used to prevent events that trigger and sustain the condition. Once started, the allergic reaction includes the release of mediators of inflammation that produce well-known symptoms of allergic rhinitis. Treatment should consist of a step-wise, rational approach that includes site-based therapy with one or more drugs acting at different sites. The drugs used are antihistamines, decongestants, cromolyn sodium, and corticosteroids. Immunotherapy should be considered at any step, because it offers the only curative approach.

Hypertension: Current Trends and Choices in Pharmacotherapeutics

Many new choices exist in the management of hypertension. Armed with a basic understanding of the definition and causes of hypertension, the pharmacotherapeutics, and special patient populations, health care professionals should be able to optimally educate, treat, and follow up patients with hypertension. In the step-care approach, four different classes of agents may be used as Step 1 choices. Selection is determined by concurrent illnesses, patient age, or concomitant drug therapy. In emergency situations, additional choices exist. Tailoring therapy in hypertensive crises may prevent or minimize end-organ damage. These areas are reviewed, and guidelines for patient assessment and education are presented