Lasmiditan Shows Promise for Menstrual Migraine, Requires Further Safety Research

Lasmiditan is a promising treatment for menstrual migraine, offering sustained pain relief comparable to or exceeding that of triptans. However, further research is needed to fully assess its safety profile. These study results were published in Pain Therapy.

Menstrual migraine affects a substantial number of women, often leading to prolonged, severe pain and higher recurrence rates than non-menstrual migraine. Current treatment options rely primarily on triptans, which, despite their efficacy, are associated with cardiovascular risks and adverse events. Lasmiditan, a selective serotonin 5-hydroxyglutamine 1F receptor agonist, offers a novel mechanism of action that could provide an alternative for patients who do not tolerate or respond well to triptans. However, its comparative effectiveness and safety require further investigation.

To compare the efficacy and safety of lasmiditan vs triptans, researchers conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) published through December 2023. They analyzed data from 14 RCTs which included 4304 patients with menstrual migraine, comparing lasmiditan with various triptans, including sumatriptan, rizatriptan, frovatriptan, almotriptan, and zolmitriptan. Three key efficacy measures were assessed — pain freedom at 2 hours, sustained pain freedom, and pain relief at 2 hours — as well as safety outcomes based on reported adverse events (AEs).

Among the included patients, 986 received rizatriptan, 618 received zolmitriptan, 391 received sumatriptan, 336 received almotriptan, 199 received frovatriptan, 115 received naratriptan, and 110 received lasmiditan.

Lasmiditan provided significantly greater sustained pain freedom compared to rizatriptan (odds ratio (OR), 14; 95% CI, 3.1-100), while rizatriptan (OR, 1.9; 95% CI, 1.2-3.3) and sumatriptan (OR, 3.4; 95% CI, 1.9-6.3) also outperformed placebo. For pain freedom at 2 hours, both lasmiditan and triptans were superior to placebo, though differences between the drugs were not statistically significant. In terms of pain relief at 2 hours, almotriptan (OR, 3.4; 95% CI, 1.7-6.7), frovatriptan (OR, 3.1; 95% CI, 1.7-5.8), and lasmiditan (OR, 2.4; 95% CI, 1.1-5.1) were all effective, though triptans generally ranked higher in short-term efficacy.

In regard to safety, rizatriptan was linked to a significantly higher incidence of AEs (OR, 2.7; 95% CI, 1.1-7.3), while data on the safety of lasmiditan remained limited, warranting further study.

Limitations of the study include the small number of RCTs available for lasmiditan, potential bias due to varied sample sizes, and reliance on indirect comparisons in the network meta-analysis. Additionally, safety data on lasmiditan for menstrual migraine remain limited, necessitating further clinical trials.

According to the researchers, “Overall, lasmiditan is promising as an emerging therapy for the treatment of MM [menstrual migraine]. We expect it to play a vital role in the treatment of MM patients and even more types of migraine treatment.”

This article originally appeared on Clinical Pain Advisor