Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies
Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies. / de Boer, Irene; Verhagen, Iris Elsa; Souza, Marcio Nattan Portes; Ashina, Messoud.
I: Cephalalgia, Bind 43, Nr. 2, 2023, s. 1-13.Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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T1 - Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies
AU - de Boer, Irene
AU - Verhagen, Iris Elsa
AU - Souza, Marcio Nattan Portes
AU - Ashina, Messoud
N1 - Publisher Copyright: © The Author(s) 2023.
PY - 2023
Y1 - 2023
N2 - Background: For many years triptans have been the cornerstone of acute migraine treatment. Nevertheless, treatment with triptans may not always be initiated due to contraindications (seen in approximately one fifth of patients) or inadequate response (seen in approximately one third of patients). New acute therapies, including 5-hydroxytryptamine (5-HT)1F receptor agonists, also known as ditans (lasmiditan) and small molecule antagonists of the calcitonin gene-related peptide receptor, also known as gepants (rimegepant and ubrogepant), may be an effective alternative. Methods: We searched Pubmed for keywords, summarized the literature and provided a comprehensive review on the place of next generation acute migraine specific treatments among triptans. Results and conclusion: Post-hoc analyses reported no differences in efficacy of gepants/ditans between responders and non-responders to triptans, but research is hampered by lack of consensus on the definition of non-responder. Due to (partially) overlapping mechanisms of action, it remains unknown whether combination therapy with lasmiditan, gepants and triptans will have added value over monotherapy. Preclinical studies and post-hoc analyses cautiously indicate that these new drugs are safe for patients with cardiovascular risk factors. However, long-term studies are needed to prove cardiovascular safety. The risk of developing medication overuse headache may differ between triptans, ditans and gepants, but further studies are needed to confirm this difference. Head-to-head randomized controlled trials of acute therapies and combinations of therapies are needed to determine their place in migraine treatment among established therapies.
AB - Background: For many years triptans have been the cornerstone of acute migraine treatment. Nevertheless, treatment with triptans may not always be initiated due to contraindications (seen in approximately one fifth of patients) or inadequate response (seen in approximately one third of patients). New acute therapies, including 5-hydroxytryptamine (5-HT)1F receptor agonists, also known as ditans (lasmiditan) and small molecule antagonists of the calcitonin gene-related peptide receptor, also known as gepants (rimegepant and ubrogepant), may be an effective alternative. Methods: We searched Pubmed for keywords, summarized the literature and provided a comprehensive review on the place of next generation acute migraine specific treatments among triptans. Results and conclusion: Post-hoc analyses reported no differences in efficacy of gepants/ditans between responders and non-responders to triptans, but research is hampered by lack of consensus on the definition of non-responder. Due to (partially) overlapping mechanisms of action, it remains unknown whether combination therapy with lasmiditan, gepants and triptans will have added value over monotherapy. Preclinical studies and post-hoc analyses cautiously indicate that these new drugs are safe for patients with cardiovascular risk factors. However, long-term studies are needed to prove cardiovascular safety. The risk of developing medication overuse headache may differ between triptans, ditans and gepants, but further studies are needed to confirm this difference. Head-to-head randomized controlled trials of acute therapies and combinations of therapies are needed to determine their place in migraine treatment among established therapies.
KW - Lasmiditan
KW - rimegepant
KW - side effects
KW - sumatriptan
KW - ubrogepant
U2 - 10.1177/03331024221143773
DO - 10.1177/03331024221143773
M3 - Review
C2 - 36739516
AN - SCOPUS:85147391042
VL - 43
SP - 1
EP - 13
JO - Cephalalgia
JF - Cephalalgia
SN - 0800-1952
IS - 2
ER -
ID: 371016778