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KMID : 1022920210090020088
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Journal of Korean Academy of Social & Managed Care Pharmacy
2021 Volume.9 No. 2 p.88 ~ p.99
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Evaluation of the Efficacy and Safety of Eleriptan vs.New Drugs (Lasmiditan and Ubrogepant) in Patients with Acute Migraine: Systematic Review and Indirect Comparison Analysis
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Lee Sung-Min
Suh Jae-Kyung
Han Eun-A
Kang Hye-Young
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Abstract
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OBJECTIVE To compare the efficacy and safety of two new drugs for acute migraine (lasmiditan and ubrogepant) with placebo and eletriptan as well as between the two new drugs.
METHOD The PubMed, Cochrane Library, and Clinical Trial.gov databases were searched for randomized-controlled trials of Eletriptan, Lasmiditan and Ubrogepant for patients with migraine. Systematic reviewer screened the literature according to inclusion and exclusion criteria and performed quality assessment and data extraction. Review Manager 5.4 software was used for the meta-analysis. A meta-analysis of clinical studies were performed, as well as an indirect comparison of Eletriptan versus Lasmiditan, Eletripatan versus Ubrogepant and Lasmiditan versus Ubrogepant. The primary efficacy endpoint was pain-free response at 2hours. secondary efficacy endpoint was Sustained pain-free at 24 hours. In addtion, The primary safety endpoint was TEAEs and secondary safety endpoint was incidence of cardiac disorder TEAEs.
RESULTS We identified 11 single migraine attack trials, of which eight trials assessed the new drugs and three trials assessed eletriptan. The network meta analysis showed that lasmiditan and ubrogepant were statistically superior to placebo in terms of relieving pain in 2 hours (lasmiditan; OR 2.18 [1.83, 2.60]), (ubrogepant; OR 1.79 [1.44,
2.21]); however, there was no statistically significant difference between lasmiditan and ubrogepant. In contrast, eletriptan
showed higher odds of achieving pain freedom at 2 hours than lasmiditan and ubrogepant; OR 3.03 (95% CI:1.59, 5.77) and
OR 3.69 (95% CI: 1.92, 7.11). Indirect comparison results showed no differences in the odds of cardiovascular treatment emergent adverse events among lasmiditan, ubrogepant, and eletriptan in the trials. However, lasmiditan had higher odds of causing treatment emergent adverse events than ubrogepant (OR 4.79 [2.73, 8.40]).
CONCLUSION An indirect comparison showed that lasmiditan and ubrogepant provided substantial benefits relative to placebo in acute migraine patients. Moreover, they had similar benefits, but lasmiditan had more side effects. However, lasmiditan and ubrogepant are less effective than eletriptan. Long-term and large-scale randomized studies are required to confirm the study results.
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KEYWORD
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Acute migraine, eletriptan, lasmiditan, ubrogepant
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