A new systematic review and network meta-analysis has found that the three new acute migraine treatments—lasmiditan, rimegepant, and ubrogepant—were less efficacious than most triptans on 2-hour pain freedom or pain relief .The newer drugs are however are an option for patients with vascular risk.
The new meta analysis has been published in the JAMA network open.
The researchers triptans, treating, migraine treatment, JAMA, lasmiditan, calcitonin gene-related peptide antagonists, new agents for migraine, rimegepant, ubrogepantTaichung Veterans General Hospital, Taiwan, and Shuu-Jiun Wang, MD, of Taipei Veterans General Hospital, Taiwan reported that most triptans were associated with higher odds ratios (ORs) for pain freedom at 2 hours compared with lasmiditan (OR range 1.72-3.40), rimegepant (OR range 1.58-3.13), and ubrogepant (OR range 1.54-3.05).
Moreover they were also associated with higher ORs for some pain relief at 2 hours than lasmiditan (OR range 1.46-3.31), rimegepant (OR range 1.33-3.01), and ubrogepant (OR range 1.38-3.13), they noted
The researchers searched Cochrane Register of Controlled Trials, Embase, and PubMed to March 2020 for double-blind randomized clinical trials of migraine-specific acute treatments. In all 64 randomized clinical trials with 46,442 participants (74%-87% women; age range 36-43) were included. Most of the studies did not allow concomitant use of migraine prevention drugs.
Doses were restricted to those in widespread clinical use for dihydroergotamine, almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, lasmiditan, rimegepant, and ubrogepant. The primary outcome was the OR for freedom from pain 2 hours after the dose, with secondary outcomes of OR for any pain relief at 2 hours and any adverse events.
Most adverse events were mild to moderate and "the percentages of serious adverse events were low (0.0%-2.1%)," researchers noted. "Chest symptoms, including chest pain, tightness, heaviness, and pressure, accounted for 0% to 20% of the adverse events for each specific treatment."
The comparisons between lasmiditan, rimegepant, and ubrogepant were not statistically significant for both pain freedom and pain relief at 2 hours. Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists.
The researchers concluded that for pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans. However, the lack of cardiovascular risks for these new classes of migraine-specific treatments may offer an alternative to triptans.
Ditans and gepants were associated with less efficacy compared with triptans, whereas gepants were associated with fewer adverse events compared with triptans.
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