Study Examines Lasmiditan Used With, Without Migraine Preventives

Lasmiditan is often considered an effective acute treatment of migraine; a new study, recently published in The Journal of Headache and Pain, aimed to examine the effectiveness of lasmiditan—a novel serotonin receptor agonist—when used with migraine preventives compared to those who do not use migraine preventives.

“Preventive treatments do not typically eliminate all migraine attacks. Patients using preventive drugs also need to use acute medication, making the concomitant use of preventive and acute migraine medications common,” explained the authors. “The most commonly recommended acute treatments for migraine include triptans and non-steroidal anti-inflammatory drugs (NSAIDs). However, not all patients respond sufficiently to triptans and NSAIDs, and in some patients, triptans are contraindicated due to their vasoconstrictive effects.”

Researchers used the data from 2 previous phase 3 clinical trials, SAMURAI and SPARTAN, which tested the efficacy and safety of lasmiditan. Patients were randomly selected to treat their migraine attack with oral lasmiditan of 50 mg, 100 mg, 200 mg, or a placebo. Additionally, migraine preventives were allowed if doses were stable for 3 months before the screening and were unchanged during the course of the study. Subgroups of patients using and not using preventive therapies were compared.

In total, 698 of 3981 patients used migraine preventive treatments. Of patients using preventives, all lasmiditan doses resulted in significantly more patients being pain-free at 2 hours after the dose compared to the placebo.

However, the efficacy outcomes were not significantly different among patients using or not using migraine preventives. Adverse event rates were also similar for all patients.

“Some patients were using botulinum toxin type A, a treatment generally reserved for patients with chronic migraine; these patients may have met the trial requirement of 3 to 8 migraine attacks per month because of their use of botulinum toxin type A. This post hoc analysis is important because patients using versus not using preventives may have differential responses to acute treatment,” noted the study. “The results show that the efficacy and safety of lasmiditan in patients using and not using migraine preventives were similar.”

The study results confirm the efficacy of lasmiditan and reveal that there is no significant increased safety or tolerability for those who also use migraine preventive medications.

Reference

Loo L, Ailani J, Schim J, et al. Efficacy and safety of lasmiditan in patients using concomitant migraine preventive medications: findings from SAMURAI and SPARTAN, two randomized phase 3 trials [published online July 24, 2019]. The Journal of Headache and Pain. doi.org/10.1186/s10194-019-1032-x.