Drug Labeling Linked to Drug, Placebo Efficacy in Migraine

Posted on Fri, Jan 10, 2014
Drug Labeling Linked to Drug, Placebo Efficacy in Migraine

Effect of placebo and active drug increased with progressively positive drug information

THURSDAY, Jan. 9, 2014 (HealthDay News) -- For patients with episodic migraine, the information provided about drug/placebo impacts drug effects, according to a study published in the Jan. 8 issue ofScience Translational Medicine.

Slavenka Kam-Hansen, M.D., Ph.D., from Harvard Medical School in Boston, and colleagues conducted a prospective, within-subject, repeated-measures study involving 66 subjects with episodic migraine to examine how variations in medication labeling modify placebo and drug effects. An initial attack in which no treatment was provided served as a control. In six subsequent attacks, patients received placebo or 10-mg rizatriptan (Maxalt), administered under three information conditions: negative (told placebo), neutral (told Maxalt or placebo), and positive (told Maxalt). The treatment was given in a randomized order.

The researchers found that Maxalt was superior to placebo for pain relief. The placebo effect increased progressively when participants were given placebo labeled as placebo, placebo or Maxalt, or Maxalt. The efficacy of Maxalt progressed similarly. Similar efficacies were seen for Maxalt labeled as placebo and placebo labeled as Maxalt. Open-label placebo was more efficacious than no treatment. Placebo, under each information condition, accounted for more than 50 percent of the drug effect, relative to no treatment. During migraine attacks, the efficacy of both placebo and medication increased incrementally with increasing positive information. Even if placebo was honestly described, its benefits persisted.

"Whether treatment involves medication or placebo, the information provided to patients and the ritual of pill taking are important components of care," the authors write.

One author disclosed financial ties to pharmaceutical companies, including Merck, which partially funded the study and manufactures Maxalt.

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