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The latest one-off treatments for migraine offer little advantage over previously available painkillers, including triptans, a large study published in the BMJ on Thursday concludes, despite the field representing a promising niche for the pharmaceutical industry.
“Eletriptan, rizatriptan, sumatriptan and zolmitriptan are more effective than more expensive and newly marketed drugs: lasmiditan, rimegepant and ubrogepant“, concludes this study.
This work only focuses on drugs used as occasional painkillers during migraine, and not on those used as long-term treatment to prevent or limit attacks.
There is still some uncertainty about the respective benefits of different treatments for migraine, an extremely common condition that affects more than a billion people worldwide. For decades, classic painkillers – aspirin and ibuprofen – have been prescribed, as well as a family of more powerful treatments, called triptans.
In addition, a new generation of drugs has been added in recent years. Some are part of the “gepant” family, such as rimegepant – sold under the name Vydura by Pfizer – and ubrogepant – marketed under the name Ubrelvy by Abbvie -. Added to this is lasmiditan – Eli Lilly’s Reyvow -, which has a different mechanism.
The stakes are high for the pharmaceutical sector, as evidenced by Pfizer’s acquisition in 2022, for around ten billion dollars, of Biohaven, the company that developed rimegepant.
All these molecules are generally evaluated against placebo. The interest of the BMJ study is to have considered nearly 200 trials of this type to compare the drugs with each other.
In the end, “Although the recent arrival of lasmiditan, rimegepant and ubrogepant provide more options for migraine attacks, the high cost of these new drugs, as well as the significant side effects of lasmiditan, argue for reserving them as a third option.“, the researchers conclude.
They recommend considering prescribing triptans first, considering them underused given their effectiveness. And, if this is not desirable, particularly because of the cardiovascular risks associated with triptans in some patients, to favor traditional painkillers such as aspirin and ibuprofen.
Slide: The different causes of migraine