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A network meta-analysis aimed to compare Lasmiditan against Rimegepant and Ubrogepant to determine which was more effective for acute oral intervention of migraine.
Compared to Rimegepant and Ubrogepant, Lasmiditan 200 and 100 mg exhibited superior effectiveness at 2 hours and prompt commencement of action in patients suffering from migraine.
A network meta-analysis aimed to compare Lasmiditan against Rimegepant and Ubrogepant to determine which was more effective for acute oral intervention of migraine.
Data from Phase II-IV randomized controlled trials (RCTs) in individuals with episodic/chronic migraine with/without aura were discovered by a thorough literature search. Lasmiditan 50, 100, and 200 mg; Rimegepant 75 mg; and Ubrogepant 25, 50, and 100 mg were among the treatments used.
It was done to compare treatments in pairs using Bayesian random-effects/fixed-effect network meta-analysis and, when necessary, adjusting by baseline risk. Comparisons were presented in terms of odds ratios with 95% credible intervals. Two-hour pain freedom and one- and two-hour pain alleviation were among the early-onset effectiveness endpoints. Adverse drug reactions (ADRs) profiles were compiled. The network's heterogeneity and consistency were analyzed, and the robustness of the results was examined via sensitivity analysis.
Female patients made up >80% of all participants in 12 RCTs incorporated in the base case (mean age 37.9-45.7 years). Lasmiditan 100 and 200 mg had a greater chance of eliciting both pain freedom and pain alleviation at two hours compared to 75 mg Rimegepant and 25 and 50 mg Ubrogepant. Although there were fewer comparisons available, the results for pain alleviation at one hour were consistent with those at two hours.
For any outcome, there were no clinically meaningful differences between Ubrogepant, Rimegepant, or 50 mg Lasmiditan. Base case analyses and sensitivity studies both pointed in the same direction.
Differently from Ubrogepant and Rimegepant, the usage of Lasmiditan was linked with primarily neurological events, that were primarily mild or moderate in severity and self-limiting. Muscular weakness, drowsiness, dizziness, nausea/vomiting, paraesthesia, and weariness with Lasmiditan; nausea with Rimegepant; and dry mouth, somnolence, and nausea with Ubrogepant were the most frequently reported ADRs (occurrence ≥2%).
For migraineurs seeking a fast onset of action, Lasmiditan (200 mg or 100 mg) may be a promising acute therapeutic choice.
Journal of Headache and Pain
Relative efficacy of lasmiditan versus rimegepant and ubrogepant as acute treatments for migraine: network meta-analysis findings
Pepa Polavieja et al.
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