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The treatment of patients with acute migraine attacks has experienced considerable progress in recent years. Other substances active in the mechanism of action different from that of the triptans have been put on the market (but not reimbursed in France to date). These are the giants, antagonists of the CGRP receptors (calcitonin-gene related peptide, CGRP) and Lasmiditan, agonist of the serotonergic receiver 5-HT1F. In a recent publication, the PR Hans-Christoph Diener (Institute for Medical Computer Science, Biometry and Epidemiology, Université de Duisburg-Essen) and the Pr Uwe Reuter (University of Greifswald) present these new therapeutic options.
What to expect from the Gépants
The proof of the effectiveness of the Gépants in the acute migraine crisis was brought for the first time by the heads of headache with olcegalent, but has only been studied on the basis of an IV administration (New England Journal of Medicine).
Several antagonists of CGRP receptors have not been developed due to liver toxicity or oral absorption difficulties. With the rimedant, antagonist of the CGRP receptors of 3e generation, no hepatotoxic effect has been observed to date. Randomized controlled studies have shown in summary that with the rimicet (soluble tablet) at the authorized dosage of 75 mg, the probability of being released from pain after 2 hours is 20.3 %, against 10.9 % on placebo (New Journal of Medicine) et The Lancet.
The undesirable effects of the drug were very rare and were no different in a significant way of those of the placebo. Nausea, dizziness and urogenital infections were digitally more frequent under rimepecling (frequency of undesirable effects less than 2 %).
In a meta-analysis, according to other data from the authors, the ” odds ratios Were calculated for pain relief 2 hours after taking, compared to placebo. These were 4.78 for Rizatriptan (10 mg) and 4.37 for Sumatriptan (100 mg). THE ” odds ratio (Gold) for the rimpage (75 mg) compared to the placebo were 1.75. There are no direct comparative studies to date between the rimed and triptans for the treatment of acute migraine attacks.
The rimeper would therefore be theoretically adapted to patients who have contraindications to the use of triptans for the treatment of acute migraine attacks. According to PRS Diener and Reuter, the Gépants are also appropriate for patients for whom triptans are not effective. A publication based on data from the German migraine register revealed that 13.1 % of patients are in therapeutic failure after at least 2 triptans and 4 % after 3 or more. The rimetant would also act in patients in whom triptans are not effective or are insufficiently (cephalalgia).
Due to the absence of direct comparative studies with triptans, it cannot be determined if the rimed loss is sufficiently effective in this indication.
Other treatments have proven to be effective through the available data, in particular for the processing of acute migraine attacks. It is the nasal sprayer of Ubrogenant and the nasal sprayer of Zavégantant. For the moment, we do not know if they will be subject to approval in Europe, nor when it could take place.
What to expect from LasMiditan
Another relatively new active ingredient is Lasmiditan, which is a 5-HT1F receptor agonist. Unlike triptans, it does not act by vasoconstriction, but it passes the blood-brain barrier and can therefore cause central side effects. According to neurologists, a meta-analysis relating to 4 studies has shown that treatment with Lasmiditan has led to a significantly higher percentage of painless patients after 2 hours (gold 2.02) and painlessly (or 1.93), a lower clinical disability stage (gold 1.36) and a significantly lower number of patients who need an emergency drug (OR 0.49).
According to neurologists, the most frequent adverse effects were dizziness, paraesthesia, fatigue, lethargy as well as a significant risk that Lasmiditan affects the ability to drive. In addition, serotonergic syndrome can occur in the event of simultaneous treatment with other serotonergic drugs.
The meta-analysis confirms the great importance of triptans
Although new drugs expand the spectrum of therapeutic options, triptans remain, as shown in a meta-analysis published in 2024 in the British Medical Journalthe most effective against migraine attacks. However, only a little more than 7 % of the people concerned take triptans, despite high efficiency, good general tolerance and relatively low treatment costs. This is why the German Neurology Society called doctors last year to adequately inform the people concerned and to expand the use of triptans.
The authors of meta-analysis, including Hans-Christoph Diener, evaluated the results of 137 randomized and controlled studies in 89,445 patients who used 17 different drugs or placebos to treat migraine attacks. Efficiency was evaluated according to the number of migrainers who were no longer suffering at all 2 hours after taking the medication in question. Another success criterion was the percentage of people whose headache had significantly improved within 2 hours of taking. Improvement was defined as a decrease in severe or moderate headache, allowing them to pass to light or non -existent headache. In addition, the undesirable effects of drugs have also been assessed.
The active reference principle for this vast meta-analysis was sumatriptan. For the evaluation criterion ” without pain after 2 hours The most effective medication was elertriptan, followed by rizatriptan, zolmitritan and sumatriptan. The new lasmiditan antimigraine drugs and the gepants were less effective than triptans. Their effectiveness was comparable to that of acetylsalicylic acid or non-steroidal anti-inflammatory drugs. It was paracetamol that was the least effective.
Regarding the evaluation criterion ” Improvement of headache within 2 hours after taking treatment The triptans were also superior. They were more effective than new antimigrainers and traditional painkillers.
This article has been translated fromUnivadis.de. The content was reviewed by the editorial staff before publication.
