Triptan use in elderly over 65 years and the risk of hospitalization for serious vascular events

Phuong Thao Tran; Maryse Lapeyre-Mestre; Baricault Berangere; Michel Lanteri-Minet; Aurore Palmaro; Anne Donnet; Joëlle Micallef

doi:10.1186/s10194-024-01770-x

Triptan use in elderly over 65 years and the risk of hospitalization for serious vascular events

J Headache Pain. 2024 Apr 26;25(1):68. doi: 10.1186/s10194-024-01770-x.

Authors

Phuong Thao Tran^{1

2}, Maryse Lapeyre-Mestre^{1

3}, Baricault Berangere^{1

3}, Michel Lanteri-Minet^{4

5}, Aurore Palmaro¹, Anne Donnet^{4

6}, Joëlle Micallef⁷

Affiliations

¹ Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France.
² College of Pharmacy, Seoul National University, Seoul, South Korea.
³ PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre d'Investigation Clinique Inserm (CIC 1436), Université de Toulouse, Toulouse, France.
⁴ Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France.
⁵ Département d'évaluation et de traitement de la douleur, CHU de Nice, FHU InovPain Université Côte Azur, Nice, France.
⁶ Centre d'Evaluation et de Traitement de la douleur, FHU InovPain Pôle Neurosciences Cliniques, APHM, Marseille, France.
⁷ service de pharmacologie clinique & pharmacosurveillance, centre régional de pharmacovigilance, Aix-Marseille université, Inserm, UMR 1106, Assistance publique-Hôpitaux de Marseille, Hopital Sainte Marguerite 270, boulevard sainte Marguerite, Marseille, 13009, France. joelle.micallef@ap-hm.fr.

Abstract

Background: Several studies have focused on the use of triptan and the risk of acute vascular events but the existence of such association is still debated and has never been quantified in patients over 65 years. To assess whether triptan use among older is associated with an increased risk of hospitalization for acute vascular events.

Methods: A propensity score-matched cohort study was designed using the French national health insurance database linked to hospital stays. Patients aged ≥ 65 years, newly treated by triptans between 2011 and 2014, were included… The primary event was hospitalization for an acute ischemic vascular event within de 90 days following triptan initiation. Association with triptan exposure was investigated through cox regression model, considering exposure at inclusion, and with exposure as a time-varying variable A case-crossover (CCO) and a self-controlled case series (SCCS) analyses were also conducted to address potential residual confounding.

Results: The cohort included 24, 774 triptan users and 99 096 propensity matched controls (mean (SD) age: 71 years (5.9), 74% of women). Within 90 days after cohort entry, 163 events were observed in the triptan group, and 523 in the control group (0.66% vs. 0.53%, adjusted hazard ratio (aHR) _{exposed/not exposed} 1.25 95%CI [1.05-1.49]; aHR _time-varying 8.74 [5.21-14.66]). The association was significant (CCO) for all events (adjusted odds ratio (aOR1.63 [1.22-2.19]) with a more consistent association with cerebral events (aOR 2.14 [1.26-3.63]). The relative incidence (RI) for all events was 2.13 [1.76-2.58] in the SCCS, for cardiac (RI: 1.67 [1.23-2.27]) and for cerebral events (RI: 3.20, [2.30-4.45]).

Conclusion: The incidence of acute vascular events was low among triptan users. We found that triptan use among older may be associated with a low increased risk for acute vascular events, which may be more marked for cerebral events such as stroke, than for cardiac events.

Keywords: Elderly; Myocardial infarction; Stroke; Triptan.

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Female
France / epidemiology
Hospitalization* / statistics & numerical data
Humans
Male
Propensity Score
Tryptamines* / adverse effects
Tryptamines* / therapeutic use

Substances

Tryptamines