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Abstract Details

Comparative Efficacy and Safety of Rimegepant Versus Ubrogepant and Lasmiditan for Acute Treatment of Migraine: A Network Meta-analysis (NMA)
Headache
P6 - Poster Session 6 (12:00 PM-1:00 PM)
7-002
Triptans are the current standard of care for the acute treatment of moderate to severe migraine attacks. Despite a demonstrated clinical benefit, response to treatment has been shown to decrease over time and triptans are contraindicated in patients with cardiovascular conditions. The safety and efficacy of new acute treatments in development (rimegepant, ubrogepant, lasmiditan) have been investigated independently vs. placebo, but not compared head-to-head.  

The objective was to conduct an NMA to compare rimegepant, ubrogepant, and lasmiditan in the acute treatment of migraine.

In the absence of a direct head-to-head comparison, a fixed-effects NMA of placebo-controlled trials was conducted for rimegepant 75mg (orally dissolving tablet), ubrogepant 25mg, 50mg, 100mg (oral), and lasmiditan 50mg, 100mg, and 200mg (oral). Efficacy outcomes included sustained pain freedom and pain relief 2-24 hours post-dose. Safety outcomes included somnolence and dizziness.
For all active comparators, a significant increase in 2-24 hour pain freedom was observed vs placebo. Rimegepant showed significant superiority in 2-24 hour pain freedom vs lasmiditan 50mg (difference 10.4% [95% CI 3.4-18.8%]) and 100mg (9.4% [2.6-17.6%]) and ubrogepant 25mg (10.3% [2.4%-19.1%]) and 50mg (9.1% [1.8-17.6%]), and comparable with the higher doses of both drugs. For 2-24 hour pain relief, rimegepant was comparable with all doses of ubrogepant (data unavailable for lasmiditan). Rimegepant was associated with significantly less dizziness compared with lasmiditan 100mg (-9.5% [-15.1-4.8%]) and 200mg (-10.9% [-17.1%-5.9%]), and a non-significant trend in reduced somnolence compared with ubrogepant 100mg and all doses of lasmiditan.
Rimegepant was found to be more efficacious than placebo and lower doses of lasmiditan and ubrogepant with respect to sustained pain freedom. Higher doses of lasmiditan were found to be associated with increased dizziness. Limitations to the analysis include limited events with which to precisely estimate safety outcomes.
Authors/Disclosures
Karissa Johnston
PRESENTER
Karissa Johnston has nothing to disclose.
Evan Popoff Evan Popoff has nothing to disclose.
Alison Deighton Alison Deighton has nothing to disclose.
Parisa Dabirvaziri No disclosure on file
Diego Fernandez-Vial (University of Kentucky) Linda Harris has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Linda Harris has received stock or an ownership interest from Biohaven Pharmaceuticals.
Alexandra Thiry Alexandra Thiry has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Alexandra Thiry has received stock or an ownership interest from Biohaven Pharmaceuticals.
Robert Croop, MD Dr. Croop has received personal compensation for serving as an employee of Biohaven Pharmaceuticals, Inc. Dr. Croop has received personal compensation for serving as an employee of Pfizer Inc.. Dr. Croop has stock in Biohaven Pharmaceutical Holding Co Ltd. Dr. Croop has stock in Biohaven Ltd.. Dr. Croop has received intellectual property interests from a discovery or technology relating to health care.
Vladimir *use 173444 Coric No disclosure on file
Gilbert J. L'Italien Gilbert J. L'Italien has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Gilbert J. L'Italien has stock in biohaven pharmaceuticals.