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2017 | 17 | 2 | 104–114
Article title

Tryptany w migrenowych bólach głowy – bilans korzyści i ryzyka

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EN
Triptans in migraine headaches – the balance of benefits and risk
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Abstracts
EN
Migraine is a very common problem affecting ca. 15–18% of women and 6% of men. Chronic migraine occurs in ca. 2% of the general population and is associated with the abuse of analgesics. There is a small number of medicines which have a proven prophylaxis effect in episodic and chronic migraine. Such a large market resulting from the epidemiology has been interesting for pharmaceutical companies for years which has led to the inventing of a group of medications referred to as triptans. This group owes its name to the presence of tryptamine in the molecule. Triptans are agonists of serotonin receptors – 5-HT1, mainly of the subtype B and D (5-HT1B, 5-HT1D), and they cause the constriction of vessels in the central nervous system. The result of the research carried out until now by pharmaceutical companies is the introduction of seven triptans into the market. Undoubtedly, they have achieved clinical and commercial success, however, over time it was found that they are not effective in every patient and that they induce specific adverse effects. The paper shortly discusses the pharmacokinetic aspect and the adverse effects and it more thoroughly presents particular triptans in terms of their effectiveness in comparison with the nonsteroidal anti-inflammatory drugs (if such papers have been published) and with other triptans. The conclusion includes several observations which the author deems worth attention and memorizing: 1) The biological/clinical effect of the new group of drugs referred to as triptans is similar to the effect of nonsteroidal anti-inflammatory drugs used for years. 2) The analysis of the data related to the safety of use indicates that these medications are not as safe as was thought. 3) In case of the failure of the therapy performed using one triptan another triptan should be applied because the resistance to one type of triptan does not imply the resistance to the remaining ones.
PL
Migrena jest bardzo powszechnym problemem, dotyczącym około 15–18% kobiet i 6% mężczyzn. Migrena przewlekła występuje u około 2% populacji ogólnej i wiąże się z nadużywaniem leków przeciwbólowych. Istnieje niewielka liczba leków o udowodnionym działaniu profilaktycznym w migrenie epizodycznej i przewlekłej. Tak ogromny rynek, wynikający z epidemiologii, interesuje firmy farmaceutyczne od lat, co doprowadziło do odkrycia grupy leków zwanych tryptanami. Grupa ta zawdzięcza swą nazwę obecności tryptaminy w cząsteczce. Tryptany są agonistami receptorów serotoniny – 5-HT1, głównie podtypu B i D (5-HT1B, 5-HT1D), i powodują obkurczanie się naczyń w ośrodkowym układzie nerwowym. Rezultatem dotychczasowych badań naukowych realizowanych przez firmy farmaceutyczne jest wprowadzenie na rynek siedmiu tryptanów. Niewątpliwie odniosły one sukces kliniczny i komercyjny, jednak z biegiem czasu okazało się, że nie u wszystkich pacjentów są skuteczne i  że wywołują specyficzne działania niepożądane. W  pracy pokrótce omówiono aspekt farmakokinetyczny i działania niepożądane, szerzej zaś poszczególne tryptany pod względem skuteczności w porównaniu z niesteroidowymi lekami przeciwzapalnymi (jeśli takie prace opublikowano) i innymi tryptanami. W podsumowaniu sformułowano kilka wniosków, które według autora są godne uwagi i zapamiętania: 1) Efekt biologiczny/kliniczny nowej grupy leków zwanych tryptanami jest podobny do efektu stosowanych od lat niesteroidowych leków przeciwzapalnych. 2) Analiza danych dotyczących bezpieczeństwa stosowania wskazuje, że leki te nie są tak bezpieczne, jak sądzono. 3) W razie niepowodzenia terapii pierwszym tryptanem należy zastosować inny, gdyż oporność na jeden rodzaj tryptanu nie warunkuje oporności na pozostałe.
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Volume
17
Issue
2
Pages
104–114
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References
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