A meta-analysis 1 including 53 studies with a total of 31 797 subjects was abstracted in DARE. For the outcome of headache response at 2 hours, sumatriptan 100 mg was more effective than placebo (mean risk difference [RD] 29%, 95% CI 26 to 34). In indirect comparison, eletriptan 80 mg (mean RD 42%, 95% CI 36 to 48) seemed to be significantly better than sumatriptan 100 mg, while frovatriptan (mean RD 17%, 95% CI 13 to 20) seemed to be significantly worse. For the outcome pain-free at 2 hours, sumatriptan 100 mg was significantly more effective than placebo (mean RD 19%, 95% CI 17 to 22). Mean RDs were significantly higher for rizatriptan 10 mg and eletriptan 80 mg, but these also were indirect comparisons. The recurrence rates with sumatriptan 100 mg were significantly lower than with placebo (RR 30%, 95% CI 27 to 33). According to indirect comparisons, recurrence rates were lower for eletriptan 40 mg and 80 mg, and higher for rizatriptan 5 mg and 10 mg. Sumatriptan 100 mg had a mean RD of any adverse effect of 13% (95% CI 8 to 18).
In direct comparisons with sumatriptan 100 mg, cafergot 2 mg showed lower efficacy but fewer central nervous system adverse effects; zolmitriptan 5 mg showed no differences; naratriptan showed lower efficacy at 4 hours and fewer adverse effects; rizatriptan 10 mg was superior for the pain-free outcome; eletriptan 40 mg and 80 mg were both superior, although the 80 mg dose showed more adverse effects; almotriptan 12.5 mg showed no difference on efficacy end points but caused fewer adverse effects.
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