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Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: A Systematic Review and Meta-analysis.
JAMA Netw Open. 2021 10 01; 4(10):e2128544.JN

Abstract

Importance

New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1F receptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant).

Objective

To compare outcomes associated with the use of lasmiditan, rimegepant, and ubrogepant vs triptans for acute management of migraine headaches.

Data Sources

The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to March 5, 2020.

Study Selection

Double-blind randomized clinical trials examining current available migraine-specific acute treatments were included.

Data Extraction and Synthesis

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to extract the data according to a predetermined list of variables of interest, and all network meta-analyses were conducted using a random-effects model.

Main Outcomes and Measures

The primary outcome was the odds ratio (OR) for freedom from pain (hereafter referred to as pain freedom) at 2 hours after the dose, and the secondary outcomes were ORs for pain relief at 2 hours after the dose and any adverse events.

Results

A total of 64 randomized clinical trials were included (46 442 participants; 74%-87% women; age range, 36-43 years). Most of the included treatments were associated with reduced pain at 2 hours compared with placebo. Most triptans were associated with higher ORs for pain freedom at 2 hours compared with lasmiditan (range: OR, 1.72 [95% CI, 1.06-2.80] to OR, 3.40 [95% CI, 2.12-5.44]), rimegepant (range: OR, 1.58 [95% CI, 1.07-2.33] to OR, 3.13 [95% CI, 2.16-4.52]), and ubrogepant (range: OR, 1.54 [95% CI, 1.00-2.37] to OR, 3.05 [95% CI, 2.02-4.60]). Most triptans were associated with higher ORs for pain relief at 2 hours compared with lasmiditan (range: OR, 1.46 [95% CI, 1.09-1.96] to OR, 3.31 [95% CI, 2.41-4.55]), rimegepant (range: OR, 1.33 [95% CI, 1.01-1.76] to OR, 3.01 [95% CI, 2.33-3.88]), and ubrogepant (range: OR, 1.38 [95% CI, 1.02-1.88] to OR, 3.13 [95% CI, 2.35-4.15]). The comparisons between lasmiditan, rimegepant, and ubrogepant were not statistically significant for both pain freedom and pain relief at 2 hours. Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists.

Conclusions and Relevance

For pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans. However, the lack of cardiovascular risks for these new classes of migraine-specific treatments may offer an alternative to triptans.

Links

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Authors+Show Affiliations

Yang CP
Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan. Department of Nutrition, Hungkuang University, Taichung, Taiwan.
Liang CS
Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Chang CM
Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Yang CC
Department of Healthcare Administration, Asia University, Taichung, Taiwan.
Shih PH
Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Department of Chinese Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
Yau YC
Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung, Taipei, Taiwan.
Tang KT
College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan. PhD Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
Wang SJ
College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.

MeSH

AdultFemaleHumansMaleMigraine DisordersTryptamines

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

34633423

Citation

Yang, Chun-Pai, et al. "Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: a Systematic Review and Meta-analysis." JAMA Network Open, vol. 4, no. 10, 2021, pp. e2128544.
Yang CP, Liang CS, Chang CM, et al. Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: A Systematic Review and Meta-analysis. JAMA Netw Open. 2021;4(10):e2128544.
Yang, C. P., Liang, C. S., Chang, C. M., Yang, C. C., Shih, P. H., Yau, Y. C., Tang, K. T., & Wang, S. J. (2021). Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: A Systematic Review and Meta-analysis. JAMA Network Open, 4(10), e2128544. https://doi.org/10.1001/jamanetworkopen.2021.28544
Yang CP, et al. Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: a Systematic Review and Meta-analysis. JAMA Netw Open. 2021 10 1;4(10):e2128544. PubMed PMID: 34633423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: A Systematic Review and Meta-analysis. AU - Yang,Chun-Pai, AU - Liang,Chih-Sung, AU - Chang,Ching-Mao, AU - Yang,Cheng-Chia, AU - Shih,Po-Hsuan, AU - Yau,Yun-Chain, AU - Tang,Kuo-Tung, AU - Wang,Shuu-Jiun, Y1 - 2021/10/01/ PY - 2021/10/11/entrez PY - 2021/10/12/pubmed PY - 2022/1/12/medline SP - e2128544 EP - e2128544 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 10 N2 - Importance: New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1F receptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant). Objective: To compare outcomes associated with the use of lasmiditan, rimegepant, and ubrogepant vs triptans for acute management of migraine headaches. Data Sources: The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to March 5, 2020. Study Selection: Double-blind randomized clinical trials examining current available migraine-specific acute treatments were included. Data Extraction and Synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to extract the data according to a predetermined list of variables of interest, and all network meta-analyses were conducted using a random-effects model. Main Outcomes and Measures: The primary outcome was the odds ratio (OR) for freedom from pain (hereafter referred to as pain freedom) at 2 hours after the dose, and the secondary outcomes were ORs for pain relief at 2 hours after the dose and any adverse events. Results: A total of 64 randomized clinical trials were included (46 442 participants; 74%-87% women; age range, 36-43 years). Most of the included treatments were associated with reduced pain at 2 hours compared with placebo. Most triptans were associated with higher ORs for pain freedom at 2 hours compared with lasmiditan (range: OR, 1.72 [95% CI, 1.06-2.80] to OR, 3.40 [95% CI, 2.12-5.44]), rimegepant (range: OR, 1.58 [95% CI, 1.07-2.33] to OR, 3.13 [95% CI, 2.16-4.52]), and ubrogepant (range: OR, 1.54 [95% CI, 1.00-2.37] to OR, 3.05 [95% CI, 2.02-4.60]). Most triptans were associated with higher ORs for pain relief at 2 hours compared with lasmiditan (range: OR, 1.46 [95% CI, 1.09-1.96] to OR, 3.31 [95% CI, 2.41-4.55]), rimegepant (range: OR, 1.33 [95% CI, 1.01-1.76] to OR, 3.01 [95% CI, 2.33-3.88]), and ubrogepant (range: OR, 1.38 [95% CI, 1.02-1.88] to OR, 3.13 [95% CI, 2.35-4.15]). The comparisons between lasmiditan, rimegepant, and ubrogepant were not statistically significant for both pain freedom and pain relief at 2 hours. Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists. Conclusions and Relevance: For pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans. However, the lack of cardiovascular risks for these new classes of migraine-specific treatments may offer an alternative to triptans. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/34633423/Comparison_of_New_Pharmacologic_Agents_With_Triptans_for_Treatment_of_Migraine:_A_Systematic_Review_and_Meta_analysis_ DB - PRIME DP - Unbound Medicine ER -