Rimegepant, Ubrogepant, Lasmiditan All Safe and Effective for Acute Migraine Treatment

Rimegepant (Nurtec ODT; Biohaven) had the lowest number needed to treat for sustained pain freedom from migraine.

Data from a recent study presented at the 2021 American Headache Society (AHS) Annual Scientific Meeting, June 3-6, suggest that rimegepant (Nurtec ODT; Biohaven), ubrogepant (Ubrelvy; Abbvie), and lasmiditan (Reyvow; Eli Lilly) are all effective in treating acute migraine compared to placebo, with acceptable safety profiles.

These findings were presented by Karissa Johnston, PhD, principal and scientific director, Broadstreet Health Economics & Outcomes Research; and adjunct professor, School of Pharmacy, Memorial University, Newfoundland. Johnston and colleagues sought to develop and compare benefit-risk profiles for the 3 medications using evidence from their published clinical trials.

“The safety and efficacy of these treatments have been investigated independently vs placebo but not compared in head-to-head trials. The absence of comparative data limits the ability to make evidence-based prescribing decisions,” the authors wrote in the poster. Johnston and colleagues analyzed data from the 5 randomized, placebo-controlled trials (n = 10,060) that had assessed the efficacy and safety of rimegepant 75-mg orally dissolving tablets; ubrogepant 25-mg, 50-mg, and 100-mg oral tablets; and lasmiditan 50-mg, 100-mg, and 200-mg oral tablets. 

The investigators found that all interventions were more effective than placebo for pain freedom and pain relief from 2-24 hours post-dose, except for lasmiditan, which had no trial data for the 2-24-hour pain relief time frame. 

READ MORE: Atogepant Sustains 1-Year Efficacy in Migraine in Extension Trial

In comparing medications, the investigators found that rimegepant 75 mg had a low number needed to treat (NNT) to achieve sustained pain freedom at 2-24 hours (7; 95% CI, 5-
12). In comparison, ubrogepant 25 mg had an NNT of 24 (95% CI, 10-166), ubrogepant 50 mg had an NNT of 19 (95% CI, 11-49), and ubrogepant 100 mg had an NNT of 13 (95% CI, 7-33). Lasmiditan 50 mg had an NNT of 26 (95% CI, 13-95), lasmiditan 100 mg had an NNT of 20 (95% CI, 12-44), and lasmiditan 200 mg had an NNT of 12 (95% CI, 8-18).

The NNT to achieve sustained pain relief at 2-24 hours was 5 (95% CI, 4-7) for rimegepant 75 mg, 8 (95% CI, 5-16) for ubrogepant 25 mg, 6 (95% CI, 5-9) for ubrogepant 50 mg, and 5 (95% CI, 4-8) for ubrogepant 100 mg.

Johnston and colleagues also looked at the number needed to harm (NNH) and observed that for dizziness, rimegepant 75 mg and ubrogepant 100 mg and 50 mg had a protective effect compared to placebo. Ubrogepant 25 mg had an NNH of 54 (95% CI, –1332 to 1379), lasmiditan 50 mg had an NNH of 28 (95% CI, 15-62), lasmiditan 100 mg had an NNH of 11 (95% CI, 7-17), and lasmiditan 200 mg had an NNH of 9 (95% CI, 6-15).

For nausea, the NNH was 24 (95% CI, 4-229) for rimegepant 75 mg, 99 (95% CI, -2580 to 2378) for ubrogepant 25 mg, 83 (95% CI, -3377 to 3471) for ubrogepant 50 mg, 47 (95% CI, 16-265) for ubrogepant 100 mg, 65 (95% CI, 18-485) for lasmiditan 50 mg, 72 (95% CI, 27-340) for lasmiditan 100 mg, and 49 (95% CI, 21-144) for lasmiditan 200 mg.

“In the acute treatment of migraine, all 3 active interventions were more effective than placebo, with acceptable safety profiles. Compared to all doses of lasmiditan and ubrogepant, the NNT to achieve immediate (2 hours) and sustained (2-24 hours) pain freedom and pain relief was lower for rimegepant 75 mg (except for lasmiditan 200 mg for pain freedom at 2 hours),” Johnston et al concluded.

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REFERENCE
Johnston K, Powell L, Popoff E, et al. Rimegepant 75 Mg, Ubrogepant, and Lasmiditan in the acute treatment of migraine applying the benefit-risk method of likelihood of being helped or harmed. Presented at 2021 AHS Annual Scientific Meeting; June 3-6. Abstract P84.