Drug Safety in Episodic Migraine Management in Adults Part 1: Acute Treatments

Orlova, Yulia; Mehla, Sandhya; Chua, Abigail L.

doi:10.1007/s11916-022-01057-3

Cited by 5 publications

(7 citation statements)

References 107 publications

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“…Over the last years, several N2B nasal drugs have already been approved by the FDA, such as Narcan ® (naloxone) for opioid addiction ( 9 ), Onzetra ® Xsail ® (sumatriptan) for migraine ( 10 ), and Trudhesa™ (dihydroergotamine mesylate) also for migraine ( 11 ). The most striking similarity in these products is their rapid onset of action and their formulation, which are all based on a dry powder form.…”

Section: Introductionmentioning

confidence: 99%

Instillation of a Dry Powder in Nasal Casts: Parameters Influencing the Olfactory Deposition With Uni- and Bi-Directional Devices

Rigaut

Deruyver

Goole

et al. 2022

Front. Med. Technol.

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Nose-to-brain delivery is a promising way to reach the central nervous system with therapeutic drugs. However, the location of the olfactory region at the top of the nasal cavity complexifies this route of administration. In this study, we used a 3D-printed replica of a nasal cavity (a so-called “nasal cast”) to reproduce in vitro the deposition of a solid powder. We considered two different delivery devices: a unidirectional device generating a classical spray and a bidirectional device that relies on the user expiration. A new artificial mucus also coated the replica. Five parameters were varied to measure their influence on the powder deposition pattern in the olfactory region of the cast: the administration device, the instillation angle and side, the presence of a septum perforation, and the flow rate of possible concomitant inspiration. We found that the unidirectional powder device is more effective in targeting the olfactory zone than the bi-directional device. Also, aiming the spray nozzle directly at the olfactory area is more effective than targeting the center of the nasal valve. Moreover, the choice of the nostril and the presence of a perforation in the septum also significantly influence the olfactory deposition. On the contrary, the inspiratory flow has only a minor effect on the powder outcome. By selecting the more efficient administration device and parameters, 44% of the powder can reach the olfactory region of the nasal cast.

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Section: Introductionmentioning

confidence: 99%

Instillation of a Dry Powder in Nasal Casts: Parameters Influencing the Olfactory Deposition With Uni- and Bi-Directional Devices

Rigaut

Deruyver

Goole

et al. 2022

Front. Med. Technol.

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“…Serotonin syndrome, an additive effect of alcohol and possible bradycardia with other medications are all drug-drug interactions and risks that will need to be considered as increased prescribing of this drug within clinical practice occurs [53].…”

Section: Trial Evidence In Migrainementioning

confidence: 99%

New Oral Drugs for Migraine

Karsan

Goadsby

2022

CNS Drugs

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Migraine is a common and disabling neurological disorder, with several manifestations, of which pain is just one. Despite its worldwide prevalence, there remains a paucity of targeted and effective treatments for the condition, leaving many of those affected underserved by available treatments. Work over the last 30+ years has recently led to the emergence of the first targeted acute and preventive treatments in our practice since the triptan era in the early 1990s, which are changing the landscape of migraine treatment. These include the monoclonal antibodies targeting calcitonin gene-related peptide or its receptor. Evolving work on novel therapeutic targets, as well as continuing to exploit drugs used in other disorders that may also have a therapeutic effect in migraine, is likely to lead to more and more treatments being able to be offered to migraineurs. Future work involves the development of agents that lack vasoconstrictive effects, such as lasmiditan, do not contribute to medication overuse, such as the gepants, and do not interact with other drugs that may be used for the disorder, as well as agents that can act both acutely and preventively, thereby utilising the quantum between acute and preventive drug effects which has been demonstrated with different migraine drugs before. Here we discuss the evolution of oral migraine treatments over the last 5 years, including those that have gained regulatory approval and reached clinical practice, those in development and potential other targets for the future.

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“…[12] Current available treatment options for acute migraine attacks include acetaminophen, triptans, ergotamine derivatives, antiemetic medications, and nonsteroidal anti-inflammatory drugs. [13][14][15] The management of acute migraine episodes primarily aims to provide rapid and effective relief from pain and associated symptoms, while minimizing adverse effects and the risk of medication overuse. [16,17] Despite the availability of these treatments, a significant proportion of patients do not achieve satisfactory relief, experience intolerable side effects, or have contraindications to their use.…”

Section: Introductionmentioning

confidence: 99%

Zavegepant nasal spray for the acute treatment of migraine: A meta analysis

Waqas,

Ansari,

Nazir

et al. 2023

Medicine

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Background: Zavegepant nasal spray is a novel CGRP receptor antagonist that has been developed for the acute treatment of migraine – a prevalent disease leading to disability and economic burden. The meta-analysis aims to quantify the efficacy of Zavegepant compared to standard care or placebo in achieving pain freedom, freedom from most bothersome symptoms (MBS), sustained pain freedom, and pain relapse at 2 to 48 hours. Methods: Databases and registers were systematically searched to identify relevant clinical trials. Two independent reviewers used a standardized data extraction form to collect relevant data on primary and secondary outcomes. Statistical analysis was performed in RevMan 5.4 software. The efficacy of Zavegepant was compared to placebo using odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic, chi-square test, Z value, and P value. Cochrane ROB-2 and ROBINS-I tools were used to assess the biases (osf.io/b32ne). Results: Of 36 identified studies, 3 were included in this meta-analysis. Zavegepant was more effective in achieving pain freedom (OR: 1.6, P < .00001), and freedom from MBS at 2 hours (OR = 1.4, P < .00001). The intervention group demonstrated a higher likelihood of sustained pain freedom between 2 and 48 hours (OR = 1.74, P < .00001). Although there was a trend towards reduced pain relapse between 2 and 48 hours in the intervention group, the difference was insignificant (OR = 0.67, P = .11). Conclusion: This meta-analysis confirms the effectiveness of Zavegepant nasal spray in treating acute migraine, with significant improvements in pain and symptom relief. Further research is needed to determine the effect on pain relapse and overall safety.

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Drug Safety in Episodic Migraine Management in Adults Part 1: Acute Treatments

Cited by 5 publications

References 107 publications

Instillation of a Dry Powder in Nasal Casts: Parameters Influencing the Olfactory Deposition With Uni- and Bi-Directional Devices

Instillation of a Dry Powder in Nasal Casts: Parameters Influencing the Olfactory Deposition With Uni- and Bi-Directional Devices

New Oral Drugs for Migraine

Zavegepant nasal spray for the acute treatment of migraine: A meta analysis

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