Zolmitriptan

MONDAY, Sept. 23, 2024 -- All active interventions show superior efficacy to placebo for freedom from pain, and most do for sustained pain freedom, for the acute treatment of migraine among adults, according to a review published online Sept. 18 in The BMJ . William K. Karlsson, from the Danish Headache Centre at Copenhagen University Hospital-Rigshospitalet, and colleagues conducted a systematic review and network meta-analysis to compare all licensed drug interventions as oral monotherapy for acute treatment of migraine episodes in adults. Data were included from 137 randomized controlled trials involving 89,445 participants allocated to one of 17 active interventions or placebo. The researchers found that compared with placebo, all active interventions showed superior efficacy for pain freedom at two hours (odds ratios from 1.73 for naratriptan to 5.19 for eletriptan), and most also showed superior efficacy for sustained pain freedom to 24 hours (odds ratios from 1.71 for celecoxib to 7.58 for ibuprofen). Eletriptan was the most effective drug for pain freedom at two hours in head-to-head comparisons (odds ratios from 1.46 to 3.01), followed by rizatriptan, sumatriptan, and zolmitriptan (odds ratios, 1.59 to 2.44, 1.35 to 2.04, and 1.47 to 1.96, respectively). The most efficacious interventions for sustained pain freedom were eletriptan and ibuprofen (odds ratios from 1.41 to 4.82). "The results of this systematic review and network meta-analysis offer the best available evidence to guide the choice of acute oral drug interventions for migraine episodes," the authors write. "Our results are in line with recent observational evidence." Several authors disclosed ties to the biopharmaceutical industry. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

A meta-analysis of 137 trials of migraine drugs indicates that the newest class of treatments are less effective than the previous generation of triptan drugs in relieving acute headaches. A study from The BMJ indicates that the newest class of migraine drugs—which includes Pfizer’s Nurtec, AbbVie’s Ubrelvy and Eli Lilly’s Reyvow—is less effective in the acute treatment of migraines than a previous class of medicines.What's more, the newer drugs are no more effective in treating migraines than traditional headache remedies such as Tylenol, ibubrofen and aspirin, according to The BMJ's analysis.The study, a meta-analysis of 137 trials that together enrolled nearly 90,000 patients, indicates that the most effective treatments for migraine come from the triptan class. In head-to-head comparisons of the 17 drugs covered in the study, triptans demonstrated the best efficacy within 2 hours of use, led by eletriptan, which also delivered the best-sustained relief over 24 and 48 hours, according to the analysis.Eletriptan was brought to the market by Pfizer in 2002 and sold under the brand name Relpax. The next most effective medicines in providing relief at 2 hours were the following triptans (in order of performance): rizatriptan, sumatriptan and zolmitriptan. Rizatriptan is sold by Organon as Maxalt. GSK sells sumatriptan as Imitrex and AstraZeneca markets zolmitriptan as Zomig.“Triptans are currently widely underused, and access to the most effective triptans should be promoted globally and international guidelines updated accordingly,” the authors wrote. The BMJ analysis also concluded that the newest class of migraine treatments—which are called calcitonin gene-related peptide receptor (CGRP) antagonists—should only be used after traditional headache meds.“While the recent introduction of lasmiditan (Reyvow), rimegepant (Nurtec), and ubrogepant (Ubrelvy) has expanded options for the acute treatment of migraine, the high cost of these newer drugs, along with the substantial adverse effects of lasmiditan, suggest their use as third-line options, after the less expensive, similarly efficacious, second-line options," the authors wrote.While the BMJ study focused on acute treatment of migraines, new CGRP treatments have also been approved as preventatives. Nurtec pills, for example, were approved in 2021 for use every other day to ward off potential migraines. Much hope has been pinned on the effectiveness of CGRP drugs. In 2022, Pfizer spent $11.6 billion in a buyout of Biohaven to gain Nurtec, which rolled up sales of $928 million last year. Meanwhile, Ubrelvy, which was approved in 2019, generated $815 million in sales.Several other CGRPs—all approved in 2018 for the prevention of migraines—also remain formidable. Eli Lilly’s Emgality generated $678 million in sales last year, while Teva’s Ajovy pulled in $435 million and Amgen’s Aimovig collected $303 million. Besides those drugs, Lundbeck's Vyepti won approval in 2020 and generated about $250 million last year.