OBJECTIVES: To determine the correlation between number of distinct triptans tried and mean total time on triptan treatment (TToTT) among Danish migraine patients, using routinely collected data.

METHODS: From the Danish National Prescription Register we identified patients (≥18 years) who had redeemed at least one triptan prescription between 1998 and 2019 and subsequently discontinued treatment with triptans (defined as no further triptan prescription redemptions for at least a two-year period). They were divided into seven groups corresponding to the number of distinct triptans tried (range 1-7) before discontinuation. Mean TToTT was calculated for each group.

RESULTS: N=211,026 acquired at least one triptan during the study period. The majority tried only one distinct triptan (n=172,668), with a mean TToTT of 1.5 years, but most had limited exposure to triptans (median TToTT=0.0 years). Significantly longer means were observed between groups treated with 2 vs. 3 (p<0.001) and 3 vs. 4 (p<0.001) distinct triptans (6.6, 9.2 and 10.7 years for 2, 3 and 4 triptans respectively). However, no further increase in mean TToTT was observed when comparing groups treated with 4 vs. 5, 5 vs. 6 or 6 vs. 7 distinct triptans.

CONCLUSIONS: The study shows that mean TToTT among patients who eventually discontinued triptans altogether increased with the number of distinct triptans tried up until 4 triptans, with no further increase with >4 distinct triptans. Further research is needed to determine whether triptan discontinuation is due to inadequate symptom relief, poor tolerability or for other reasons, and to establish the likelihood of response to other triptans after failure (for whatever reason) of one or more.