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

Deng，Xinxin1,2,3; Zhou，Liying1,2,3; Liang，Cui1,2,3; Shang，Xue4; Hui，Xu2,3; Liu，Wendi1,2,3; Liang，Shanshan1,2,3; Wang，Yongsheng1,2,3; Xu，Meng1,2,3; Guo，Kangle5; Yang，Kehu2,3; Li，Xiuxia1,2,3

2024-02-05

10.1186/s10194-024-01723-4

The journal of headache and pain   影响因子和分区

1129-2369

1129-2377

OBJECTIVE: To compare the outcomes associated with the use of lasmiditan, rimegepant, ubrogepant, and zavegepant for the acute management of migraine headaches. METHODS: We searched four electronic databases from database inception to August 31, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the acute treatment of migraine. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of evidence using the CINeMA approach. We conducted frequentist network meta-analyses (NMA) to summarise the evidence. Data were analyzed using R-4.3.1. RESULTS: A total of 18 eligible studies including 10 different types of interventions with 22,429 migraine patients were included. NMA results showed that compared to ubrogepant (25 mg and 50 mg) and zavegepant, lasmiditan (100 mg and 200 mg) exhibits an elevated probability of achieving pain relief within a 2-hour interval. Similarly, relative to zavegepant, rimegepant (75 mg) and ubrogepant (50 mg and 100 mg) demonstrate an enhanced likelihood of sustaining pain relief over a 24-hour period. Furthermore, in contrast to ubrogepant (25 mg) and lasmiditan (50 mg), rimegepant (75 mg) presents a heightened probability of achieving freedom from photophobia within 2 h. Regarding safety, lasmiditan carries the highest risk of adverse events, which are associated with an increased incidence of adverse effects, including dizziness, somnolence, asthenia, paresthesia, and fatigue. CONCLUSIONS: In this NMA, a spectrum of evidence ranging from very low to high levels underscores the favorable efficacy and tolerability of rimegepant 75 mg and ubrogepant 100 mg, positioning them as potential candidates for the acute management of migraine. Concurrently, lasmiditan (100 mg and 200 mg) exhibits notable efficacy, albeit accompanied by an increased susceptibility to adverse events. These findings should still be approached with caution, primarily due to the intrinsic limitations associated with indirect comparisons.

Acute treatments CGRP Efficacy Lasmiditan Migraine Network meta-analyses

SCI

英语

其他

NEUROSCIENCE & BEHAVIOR

2-s2.0-85184082791

Scopus

1.Health Technology Assessment Center/Evidence-Based Social Science Research Center,School of Public Health,Lanzhou University,Lanzhou,199 Donggang West Road,730000,China
2.Evidence Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou,199 Donggang West Road,730000,China
3.Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province,Lanzhou,730000,China
4.School of Public Health and Emergency Management,Southern University of Science and Technology,Shenzhen,China
5.Department of infection management,Gansu Provincial Hospital,Lanzhou,730000,China

Deng，Xinxin,Zhou，Liying,Liang，Cui,et al. 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[J]. The journal of headache and pain,2024,25(1).

Deng，Xinxin.,Zhou，Liying.,Liang，Cui.,Shang，Xue.,Hui，Xu.,...&Li，Xiuxia.(2024).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.The journal of headache and pain,25(1).

Deng，Xinxin,et al."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".The journal of headache and pain 25.1(2024).