Abstract Details

Many trials have compared the efficacy and safety of subcutaneous sumatriptan with other treatments.

To provide concrete evidence regarding the efficacy and safety of subcutaneous sumatriptan compared with other treatments in patients with acute migraine attacks.

The study protocol is registered in PROSPERO (CRD42021274132). We searched PubMed, Scopus, Web of Science, and Cochrane for related randomized-controlled trials (RCTs) up to January 2021. We included RCTs reporting efficacy or safety outcomes for subcutaneous sumatriptan compared with placebo or other acute migraine treatments. Outcomes were pooled as risk ratio (RR) and 95% confidence interval (CI). Analyses were conducted in R-software using the netmeta package.

Thirty-three studies were included in this network meta-analysis. subcutaneous sumatriptan showed significant headache-free, headache relief, clinical disability relief, nausea relief, phonophobia relief, and photophobia relief rates compared with placebo. At 1-hour post-dose, IV metoclopramide showed the highest headache-free (RR=8.98, 95%CI [4.13; 19.54]) and headache relief rates (RR=4.61, 95%CI [2.75; 7.71]), subcutaneous sumatriptan showed the highest clinical disability relief (RR=3.11, 95%CI [2.36; 4.10]) and nausea relief rates (RR=1.85, 95%CI [1.08; 3.17]), and IV valproate showed the highest phonophobia relief rate (RR=3.99, 95%CI [1.66; 9.61]) compared with placebo. At 2-hours post-dose, IV metoclopramide showed the highest headache-free rate (RR=7.39, 95%CI [3.31; 16.46]), subcutaneous naratriptan showed the highest clinical disability relief (RR=3.54, 95%CI [2.64; 4.74]) and nausea relief rates (RR=2.63, 95%CI [2.00; 3.46]), and subcutaneous sumatriptan showed the highest headache relief (RR=2.71, 95%CI [2.36; 3.11]), phonophobia relief (RR=2.03, 95%CI [1.35; 3.04]), and photophobia relief rates (RR=2.13, 95%CI [1.50; 3.03]) compared with placebo. subcutaneous Sumatriptan showed higher total adverse events (AEs) but comparable serious AEs and withdrawal due to AEs to placebo.

subcutaneous sumatriptan is tolerable and effective in treating acute migraine attacks compared with placebo. However, some other treatments−e.g. IV metoclopramide−have comparable efficacy.