Abstract
Purpose
This narrative review provides an update on the research that led to the development
of ditans and lasmiditan for the acute treatment of migraine in adults and discusses
the potential advantages and disadvantages of lasmiditan in clinical use.
Methods
The electronic databases PubMed, Scopus, and ClinicalTrials.gov were searched from database inception through January 9, 2021, to identify relevant
studies. Search results were assessed for their overall relevance to this review.
Findings
Because part of the effect of the triptans is mediated by the serotonin 1F receptors,
which are not present in the smooth muscle, a pure agonist of these receptors, lasmiditan,
was developed. Lasmiditan is hypothesized to act on antinociceptive pathways and inhibit
the calcitonin gene-related peptide release. Lasmiditan was approved by the US Food
and Drug Administration in 2019 based on the results of 2 pivotal trials that found
a significant difference from placebo in the percentage of patients who achieved freedom
from pain and most bothersome symptom at 2 h. The main concern of lasmiditan derives
from its central nervous system–related adverse effects, mainly dizziness and paraesthesia,
probably attributable to its high blood brain barrier penetration. These central nervous
system adverse effects impair driving performance for hours and might be suboptimal
for individuals with migraine who want to quickly stop the migraine attack to resume
their activities as soon as possible.
Implications
Despite the advantage of being beneficial in the acute treatment of migraine without
vasocostrictive action, lasmiditan also presents limitations, in particular the central
nervous system adverse effects. Moreover, head-to-head trials against triptans and
gepants are indispensable to determine the better option for patients.
Key words
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Article info
Publication history
Published online: February 16, 2021
Accepted:
January 25,
2021
Identification
Copyright
© 2021 Elsevier Inc.