Reyvow, Nurtec ODT, Ubrelvy may be alternatives for acute migraine treatment

Reyvow, Nurtec ODT and Ubrelvy were less efficacious than triptans for treating migraines, but these new pharmacologic agents correlated with fewer adverse events, according to a study published in JAMA Network Open.

“FDA recently approved two new classes of acute anti-migraine treatments, that is, ditans (lasmiditan) and gepants (ubrogepant and rimegepant),” co-author Shuu-Jiun Wang, MD, told Healio. “This network meta-analysis compared the efficacy and safety of these two new classes to the standard specific acute anti-migraine treatment, triptans. Overall, the two new classes of acute anti-migraine treatments provide alternative options for individuals who have failed prior treatments and, moreover, the lack of cardiovascular risks of these new classes are of choice for those with cardiovascular contraindications.”

Data from the Cochrane Register of Controlled Trials, Embase and PubMed were used to identify 64 double-blind, randomized clinical trials that assessed migraine-specific acute treatments, including lasmiditan (Reyvow, Eli Lilly), rimegepant (Nurtec ODT, Biohaven) and ubrogepant (Ubrelvy, Allergan), among others. The odds ratio for pain freedom at 2 hours after the dose served as the primary outcome; other outcomes included ORs for pain relief at 2 hours after the dose and adverse events.

Ditans, gepants and triptans all reduced pain at 2 hours, but triptans were associated with greater pain freedom at 2 hours vs. lasmiditan, rimegepant and ubrogepant.

“For efficacy issues, triptans have higher odds to reduce patients’ pain from moderate to severe intensity down to mild (relief) or zero (resolution) than either gepants or ditans,” Wang said. “For safety issues, gepants are better than triptans or ditans regarding the occurrence of adverse events. However, these two new classes do not have cardiovascular risks, which is a limitation for triptans.”

No statistically significant difference in pain freedom or pain relief at 2 hours was identified in comparisons between lasmiditan, rimegepant and ubrogepant.