A meta-analysis of 137 clinical trials finds triptan drugs are among the most effective for treating migraines, while newer ditan and gepant drugs were rated less highly
By Christa Lesté-Lasserre
19 September 2024
Researchers assessed the efficacy of 17 drugs for treating migraines
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An underused category of drug appears more effective for managing migraine-related symptoms than newer, costlier medications, according to a sweeping review of clinical trials.
Despite being designed specifically to treat migraine episodes, triptan drugs are used in less than 22 per cent of migraine cases. Providing that patients have no medical conditions that preclude their use, such as cardiovascular disease, the results suggest people should consider low-cost triptans as a first-line treatment for migraine relief, says Andrea Cipriani at the University of Oxford.
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“It’s not a bad idea to pull all the data together and re-emphasise – particularly to primary care physicians – that if someone comes in with migraine and they’ve got no contraindication, and they’ve tried [non-steroidal anti-inflammatory drugs], the evidence base for using the triptans is really quite good,” says Peter Goadsby at King’s College London, who wasn’t involved in the review.
Triptans, such as sumatriptan and eletriptan, have been progressively authorised globally since 1991 and are now available as off-brand or generic tablets. However, case reports have suggested that the drugs may trigger heart attacks or strokes – especially in people with pre-existing cardiovascular issues.
To offer alternative treatments, pharmaceutical companies developed newer drugs called ditans and gepants – which have a similar mechanism of action to triptans but avoid the cardiovascular risks. Licensed only in the past few years, these drugs – lasmiditan, rimegepant and ubrogepant – come at a high cost. For example, Eli Lilly’s trademarked formulation of lasmitidan, Reyvow, retails for $92.50 per 24-hour tablet, compared with about $17 for generic eletriptan.