Newer pharmacologic agents not as good as triptans for treating migraines; JAMA
New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1F receptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant).
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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Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.