Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis.

Autor: Laohapiboolrattana W; Division of Neurology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand., Jansem P; Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand., Anukoolwittaya P; Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand. p39617@gmail.com.; Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. p39617@gmail.com.; Thai Headache Society, The Neurological Society of Thailand (NST), Bangkok, Thailand. p39617@gmail.com., Roongpiboonsopit D; Division of Neurology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand., Hiransuthikul A; Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand.; Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand., Pongpitakmetha T; Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand.; Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Thai Headache Society, The Neurological Society of Thailand (NST), Bangkok, Thailand., Thanprasertsuk S; Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand.; Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Thai Headache Society, The Neurological Society of Thailand (NST), Bangkok, Thailand., Rattanawong W; Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand.; Department of Medicine, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand.; Thai Headache Society, The Neurological Society of Thailand (NST), Bangkok, Thailand.
Jazyk: angličtina
Zdroj: The journal of headache and pain [J Headache Pain] 2024 Nov 08; Vol. 25 (1), pp. 194. Date of Electronic Publication: 2024 Nov 08.
DOI: 10.1186/s10194-024-01904-1
Abstrakt: Background: Novel abortive treatments for migraine, ditans and gepants, have promising implications in triptan-insufficient responders with minimal existing comparative data. Our study aims to synthesize evidence through a systematic review and network meta-analysis to assess the comparative efficacy of lasmiditan, rimegepant and ubrogepant in triptan-insufficient responders.
Method: We searched PubMed, Embase, CENTRAL, and EBSCO Open Dissertations up to May 2024. We included randomized controlled trials (RCTs) that compared novel abortive treatments, including lasmiditan, rimegepant, and ubrogepant, in migraine patients who self-reported insufficient response to triptans. Outcomes are represented using relative risks with corresponding 95% confidence intervals (CI). The surface under the cumulative ranking curve (SUCRA) was used to rank each medication.
Results: A total of five phase 3 RCTs involving 3,004 patients were included in the analysis. All three agents were significantly superior to placebo for two-hour pain freedom (RR = 1.93, 95% CI [1.52, 2.46]), freedom from the most bothersome symptoms at two hours (RR = 1.55, 95% CI [1.37, 1.75]), and pain relief at two hours (RR = 1.46, 95% CI [1.35, 1.58]). No statistically significant differences in efficacy outcomes were observed among the three agents. However, lasmiditan 200 mg had the highest cumulative probability for two-hour pain freedom and relief (SUCRA 0.9, 0.8, respective), while rimegepant led in relieving the most bothersome symptoms (SUCRA 0.7).
Conclusion: Lasmiditan, rimegepant, and ubrogepant are effective for acute treatment of migraine in triptan-insufficient responders, with high-dose lasmiditan showing the highest efficacy for pain control.
(© 2024. The Author(s).)
Databáze: MEDLINE
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