OBJECTIVES: In Denmark, triptans are second-line treatment for migraine, used when NSAIDs are insufficient, with guidelines recommending trial of three different triptans, each in three separate attacks, before effectiveness of triptans is ruled out. In this population-based RWE study, we examined switching between triptans among Danish patients who have tried at least three distinct triptans before discontinuation to assess the likelihood of returning to triptans they have been exposed to previously.

METHODS: From the Danish National Prescription Register we identified patients (≥18 years) who had redeemed prescriptions for at least three distinct triptans between 1998 and 2019 (i.e., with at least two switches). Discontinuation of treatment was defined as no further triptan prescription redemptions for at least a two-year period. Mean and decile switches between triptans were calculated.

RESULTS: N=211,026 patients acquired at least one triptan during the study period, of whom only 7,871 (3.7%) were identified as using at least three distinct triptans before discontinuation. Of the 7,871, 77.2% (n=6,079) used three, 18.5% used 4 (n=1,459), and 4.2% (n=333) used >4. Among the 7,871, the mean number of switches was 4.6, with 30% switching only twice, indicating treatment with three distinct triptans sequentially. Only 20% of patients had ≥5 switches, but, among the 10% of patients with most switches, ≥7 switches were observed.

CONCLUSIONS: The findings indicate that, while few patients using triptans try more than two distinct triptans, most of those who do return to triptans they have tried and switched from previously. This pattern suggests patient awareness of differences between distinct triptans in effectiveness and/or tolerability, with eventual choice of triptan influenced by experience of two or three others but rarely more. Further research is needed to understand the optimal treatment sequence – if there is one – and the optimal switching regimen, better to inform the Danish guidelines.