ABSTRACT

Objective

In the absence of head-to-head comparisons, the objective of this study was to conduct a network meta-analysis (NMA) to indirectly compare the relative efficacy and safety of rimegepant, ubrogepant, and lasmiditan for the acute treatment of migraine.

Methods

A systematic literature review was conducted to identify randomized controlled trials (RCTs) of rimegepant, ubrogepant, and lasmiditan in adults with acute migraine. Outcomes included sustained pain freedom and -relief 2–48 hours post-dose, and adverse events. No RCTs were identified that directly compared these interventions. Therefore, a fixed-effects Bayesian NMA was conducted by identifying a connected (via comparison to placebo) network of RCTs.

Results

Five RCTs were identified as follows: rimegepant study 303 (n = 1,466), ubrogepant ACHIEVE I and II (n = 1,672 and n = 1,686, respectively), and lasmiditan SAMURAI and SPARTAN (n = 2,231 and n = 3,005, respectively). Efficacy outcomes (pain freedom and relief at 2, 24, 48 hours) tended to be highest for lasmiditan 200 mg and rimegepant followed lower doses of lasmiditan and all doses of ubrogepant. However, lasmiditan 200 mg was also associated with higher rates of adverse events, particularly somnolence and dizziness.

Conclusions

Lasmiditan, rimegepant, and ubrogepant all performed significantly better than placebo with respect to pain freedom and pain relief. Efficacy results were similar for rimegepant and lasmiditan with rimegepant having higher rates of pain freedom and relief than lower doses of lasmiditan, while somnolence and dizziness outcomes were lower for rimegepant than higher doses of lasmiditan.

中文翻译：

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rimegepant、ubrogepant 和 lasmiditan 用于急性偏头痛治疗的比较疗效和安全性：网络荟萃分析

摘要

客观的

在没有头对头比较的情况下，本研究的目的是进行网络荟萃分析 (NMA)，以间接比较 rimegepant、ubrogepant 和 lasmiditan 在急性偏头痛治疗中的相对疗效和安全性。

方法

进行了系统的文献回顾，以确定 rimegepant、ubrogepant 和 lasmiditan 在成人急性偏头痛中的随机对照试验 (RCT)。结果包括给药后 2-48 小时的持续疼痛缓解和缓解以及不良事件。没有发现直接比较这些干预措施的随机对照试验。因此，通过识别 RCT 的连接（通过与安慰剂比较）网络来进行固定效应贝叶斯 NMA。

结果

五项随机对照试验确定如下：rimegepant 研究 303（n = 1,466）、ubrogepant ACHIEVE I 和 II（分别为 n = 1,672 和 n = 1,686）和 lasmiditan SAMURAI 和 SPARTAN（分别为 n = 2,231 和 n = 3,005）。lasmiditan 200 mg 的疗效结果（2、24、48 小时无疼痛和缓解）往往最高，rimegepant 遵循较低剂量的 lasmiditan 和所有剂量的 ubrogepant。然而，lasmiditan 200 mg 也与较高的不良事件发生率相关，特别是嗜睡和头晕。

结论

Lasmiditan、rimegepant 和 ubrogepant 在缓解疼痛和缓解疼痛方面的表现都明显优于安慰剂。rimegepant 和 lasmiditan 的疗效结果相似，rimegepant 比低剂量 lasmiditan 的疼痛缓解率和缓解率更高，而 rimegepant 的嗜睡和头晕结果低于高剂量 lasmiditan。