The following is a summary of “Comparison of effectiveness and safety of lasmiditan and CGRP-antagonists for the acute treatment of migraine in adults: systematic review and network meta-analysis of randomised trials,” published in the February 2024 issue of Pain by Deng et al.
Researchers conducted a retrospective study to assess the comparative effectiveness and safety of lasmiditan, rimegepant, ubrogepant, and zavegepant in treating acute migraine headaches.
They searched four electronic databases (August 31, 2023) to find RCTs reporting efficacy and safety for acute migraine treatment. The risk of bias in these RCTs was assessed using the Cochrane tool, and certainty of evidence was evaluated with the CINeMA approach. Frequentist NMA was performed to summarize the evidence. Data analysis was carried out using R-4.3.1.
The results showed 18 studies involving 10 interventions and 22,429 migraine patients. According to NMA results, lasmiditan (100 mg and 200 mg) had a higher chance of achieving pain relief within 2 hours than ubrogepant (25 mg and 50 mg) and zavegepant. Similarly, rimegepant (75 mg) and ubrogepant (50 mg and 100 mg) were more likely to sustain pain relief over 24 hours than zavegepant. Additionally, rimegepant (75 mg) had a greater chance of achieving freedom from photophobia within 2 hours compared to ubrogepant (25 mg) and lasmiditan (50 mg). Lasmiditan exhibited the highest safety risk, marked by elevated dizziness, somnolence, asthenia, paresthesia, and fatigue.
Investigators concluded a promising efficacy for rimegepant 75mg and ubrogepant 100mg in acute migraine, but caution was advised due to limitations and mixed lasmiditan evidence.
Source: thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01723-4