Efficacy, safety and indirect comparisons of lasmiditan, rimegepant, and ubrogepant for the acute treatment of migraine: A systematic review and network meta-analysis of the literature

Abstract

Background We performed a random-effects network meta-analysis to study the efficacy and safety of newly developed drugs for the acute treatment of migraine attacks. Methods MEDLINE via PubMed, Embase and The Cochrane Register of Controlled Trials were searched from inception to 11 February 2022. Phase 3 randomized controlled trials examining all formulations of lasmiditan, rimegepant and ubrogepant for the acute treatment of adults with migraine, were included. Data were extracted following the PRISMA guidelines. Results Seven studies (SAMURAI, SPARTAN, CENTURION, Study 302, Study 303, ACHIEVE I and II) involving n = 12,859 patients were included. All treatments were superior in efficacy to placebo. Lasmiditan 200 mg showed the highest two-hour pain freedom, while two-hour freedom from most bothersome symptom was equally achieved by the higher doses of lasmiditan (100 and 200 mg), rimegepant and the higher doses of ubrogepant (50 and 100 mg). The odds of treatment-emergent adverse events were greatest with all doses of lasmiditan. Conclusion Lasmiditan 200 mg was the most effective intervention in the treatment of migraine attacks, although it was associated with high degrees of dizziness, nausea and somnolence. Rimegepant showed slightly lower, but similar efficacy rates to lasmiditan. Ubrogepant had overall the best tolerability profile. These conclusions are limited by the absence of head-to-head comparisons, limitations of individual trials and of the meta-analysis methodology itself. PROSPERO trial registration: CRD42022308224

New migraine drugs: A critical appraisal of the reason why the majority of migraine patients do not receive an adequate medication

“…Three calcitonin gene-related peptide (CGRP) receptor antagonists, the so-called gepants, were developed: for the treatment of acute migraine attacks, rimegepant 75 mg, ubrogepant 50 and 100 mg and zavegepant nasal spray 10 mg. There are no significant differences in the efficacy of the three gepants, and the 95% confidence intervals of the odds ratios overlap (Table 1) (9). Unfortunately, there are no direct comparative studies between triptans, analgesics, non-steroidal anti-inflammatory drugs and the approved gepants.…”

New migraine drugs

“…The International Headache Society deems, therefore, that the composition of the author groups will provide a presentation of the efficacy and potential side effects or safety aspects of the new drugs for the treatment of acute migraine attacks and for the prevention of migraine that is as objective as possible and can be used for clinical practice. In addition to meta-analyses of efficacy and tolerability or safety for both acute and preventive medications (1–3), some of the publications address practical aspects of use, such as migraine prevention in patients with medication overuse or medication overuse headache (4), the results of open-label long-term studies for both drugs for acute therapy (5) and for migraine prophylaxis (6), and other aspects such as nonresponders to previous therapies, combination therapy switching, and termination of therapy (7,8).…”

Neues bei Kopfschmerzen 2022–2023

“…Eine Literatursuche analysierte die offenen Langzeitund Praxisstudien zu Lasmiditan, Ubrogepant und Rimegepant für die Akutbehandlung von Migräneattacken [19]. Die Wirksamkeit und Verträglichkeit aller 3 Substanzen blieben über einen längeren Zeitraum erhalten.…”