Efficacy and Safety of Lasmiditan for Acute Treatment of Migraine in Adults: A Meta‐Analysis

Abstract

Monotherapy with triptans in acute migraine is ineffective in many patients and contraindicated in certain cardiovascular diseases where alternative therapeutic options are necessary to explore. This meta‐analysis has evaluated the efficacy and safety of lasmiditan for the treatment of acute migraine in adults. After performing a literature search on MEDLINE/PubMed, Scopus, Cochrane databases, and International Clinical Trial Registry Platform, reviewers assessed eligibility and extracted data from 4 relevant articles. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were followed in the selection, analysis, and reporting of findings. A random‐effects model was used to estimate effect size. Quality assessment was done using the risk of bias assessment tool and meta‐regression for probable variables affecting effect size. Subgroup analysis was done depending on the dose of lasmiditan. Lasmiditan use was associated with a significantly higher percentage of patients with pain freedom (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.72‐2.39; P < .00001), sustained pain freedom (OR, 1.93; 95%CI, 1.55‐2.39; P <.00001), headache response (OR, 2.05; 95%CI, 1.77‐2.36; P < .00001), clinical disability level (OR, 1.36; 95%CI, 1.20‐1.55; P < .00001), patients’ global impression (OR, 1.88; 95%CI, 1.69‐2.10; P < .00001), and significantly lower use of rescue medication (OR, 0.49; 95%CI, 0.38‐0.63; P < .00001) compared to placebo. Lasmiditan use was also associated with a higher likelihood of adverse effects like dizziness (OR, 6.54; 95%CI, 4.24‐10.07; P < .00001), paresthesia (OR, 4.28; 95%CI, 2.97‐6.17; P < .00001), and fatigue (OR, 5.67; 95%CI, 3.78‐8.52; P < .00001) compared to placebo. Subgroup analysis showed a dose‐dependent effect of lasmiditan on pain freedom, sustained pain freedom, patient's global impression, and occurrence of adverse drug reactions. Prediction probability for effect estimate favoring placebo was calculated to be 0.0017%. Lasmiditan has shown a favorable effect in terms of efficacy and safety in the treatment of an acute attack of migraine in comparison to placebo. Further studies are needed to evaluate long‐term safety, efficacy, and use in specific subgroups of patients. PROSPERO Registration Number: CRD42020177838

Acute Treatment of Migraine

“…Somnolence, fatigue, nausea, and paresthesia were also experienced by 3% to 6% of patients in the active arm versus 1% to 2% in the placebo arm. Safety evaluations showed that driving was impaired after lasmiditan use at all doses, and patients reported more sedation at 8 hours after lasmiditan use compared with placebo 32,33 . Patients should therefore be counseled to avoid any activity requiring alertness, including driving, for at least 8 hours after taking lasmiditan.…”

Profile of Lasmiditan in the Acute Treatment of Migraine in Adults: Design, Development, and Place in Therapy

“…Because of lasmiditan's unique mechanism of action, headache providers have been eager to define its role in the care of patients with migraine. Several meta-analyses have been published based on data from the previously mentioned clinical trials which have demonstrated that lasmiditan is effective at relieving acute migraine pain compared with placebo [47][48][49] with several demonstrating that the 200 mg dose is more effective than the 100 mg dose. [50][51][52] When compared to triptans, lasmiditan has shown lower odds ratios for pain freedom at 2 hours compared with most triptans (OR 1.72, 95% CI 1.06-2.80 to OR 3.40 95% CI 2.12-5.44) as well as pain relief at 2 hours (OR 1.46, 95% CI 1.09-1.96 to OR 3.31, 95% CI 2.41-4.55).…”