Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis
Abstract 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...
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| Language: | English |
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BMC
2024-11-01
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| Series: | The Journal of Headache and Pain |
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| Online Access: | https://doi.org/10.1186/s10194-024-01904-1 |
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| author | Wattakorn Laohapiboolrattana Priabprat Jansem Prakit Anukoolwittaya Duangnapa Roongpiboonsopit Akarin Hiransuthikul Thanakit Pongpitakmetha Sekh Thanprasertsuk Wanakorn Rattanawong |
| author_facet | Wattakorn Laohapiboolrattana Priabprat Jansem Prakit Anukoolwittaya Duangnapa Roongpiboonsopit Akarin Hiransuthikul Thanakit Pongpitakmetha Sekh Thanprasertsuk Wanakorn Rattanawong |
| author_sort | Wattakorn Laohapiboolrattana |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-e3df1b39a46a4f10b7cf49a72612a3db |
| institution | DOAJ |
| issn | 1129-2377 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | The Journal of Headache and Pain |
| spelling | doaj-art-e3df1b39a46a4f10b7cf49a72612a3db2025-08-20T02:50:04ZengBMCThe Journal of Headache and Pain1129-23772024-11-0125111210.1186/s10194-024-01904-1Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysisWattakorn Laohapiboolrattana0Priabprat Jansem1Prakit Anukoolwittaya2Duangnapa Roongpiboonsopit3Akarin Hiransuthikul4Thanakit Pongpitakmetha5Sekh Thanprasertsuk6Wanakorn Rattanawong7Division of Neurology, Department of Medicine, Faculty of Medicine, Naresuan UniversityDepartment of Psychiatry, Faculty of Medicine, Prince of Songkla UniversityChulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn UniversityDivision of Neurology, Department of Medicine, Faculty of Medicine, Naresuan UniversityChulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn UniversityChulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn UniversityChulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn UniversityChulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn UniversityAbstract 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.https://doi.org/10.1186/s10194-024-01904-1Triptan-Insufficient ResponderGepantRimegepantUbrogepantLasmiditanAbortive Treatment |
| spellingShingle | Wattakorn Laohapiboolrattana Priabprat Jansem Prakit Anukoolwittaya Duangnapa Roongpiboonsopit Akarin Hiransuthikul Thanakit Pongpitakmetha Sekh Thanprasertsuk Wanakorn Rattanawong Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis The Journal of Headache and Pain Triptan-Insufficient Responder Gepant Rimegepant Ubrogepant Lasmiditan Abortive Treatment |
| title | Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis |
| title_full | Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis |
| title_fullStr | Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis |
| title_full_unstemmed | Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis |
| title_short | Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis |
| title_sort | efficacy of lasmiditan rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders systematic review and network meta analysis |
| topic | Triptan-Insufficient Responder Gepant Rimegepant Ubrogepant Lasmiditan Abortive Treatment |
| url | https://doi.org/10.1186/s10194-024-01904-1 |
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