BMJ
Pharmacotherapy for acute migraine: Newer drugs not necessarily better
In terms of both efficacy and tolerability, eletriptan, rizatriptan, sumatriptan, and zolmitriptan showed the best overall performance for the acute treatment of migraine. The recently marketed and more expensive drugs lasmiditan, rimegepant, and ubrogepant showed efficacy comparable to acetaminophen and most NSAIDs. Authors conclude that triptans are currently widely underused and advocate for wider access to the most effective triptans globally and for international guidelines to be updated accordingly.
- This systematic review and network meta-analysis included 137 double-blind randomized trials comprising 89,445 adults (≥18 years) with a diagnosis of migraine who were allocated to one of 17 active interventions or placebo.
- All interventions were superior to placebo for pain freedom at two hours (odds ratios [ORs] ranging from 1.73 for naratriptan to 5.19 for eletriptan), and most of them also for sustained pain freedom to 24 hours (ORs ranging from 1.71 for celecoxib to 7.58 for ibuprofen).
- In head-to-head comparisons, eletriptan was most effective for pain freedom at two hours (ORs, 1.46 to 3.01), followed by rizatriptan (ORs, 1.59 to 2.44), sumatriptan (ORs, 1.35 to 2.04), and zolmitriptan (OR, 1.47 to 1.96).
- For sustained pain freedom, the most efficacious agents were eletriptan and ibuprofen (ORs, 1.41 to 4.82).
Source:
Karlsson WK, et al. (2024, September 18). BMJ. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/39293828/