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Debate: Innovative headache treatments will be better than what we currently have - CON

Headache trials

May 10, 2014 | Length: 6:23 min


Infos

Congress:The 8th World Congress on Controversies in Neurology
Presenter:Z. Katsarava
Description:

INNOVATIVE HEADACHE TREATMENTS WILL BE BETTER THAN WHAT WE CURRENTLY HAVE – CON Zaza Katsarava, Germany
Migraine is a complex neurobiological disorder with attacks of severe disabling unilateral pulsating headache with nausea, vomiting, photo-, phono-, and osmophobia. Treatment of migraine is not easy and requires acute headache medication, preventative treatment and psychological support.
Analgesics and ergots were used for acute migraine treatment for decades, whereas, ergots were replaced by triptans in early nineties. Up-to-date triptans are the most effective anti-migraine drugs, achieving response rates of 30% (60% absolute rate minus 30% placebo effect) and pain free rate of about 20% (absolute 40% minus 20% placebo, Ferrari et al, 2001). Combination of a triptan and analgesic can increase the efficacy, e.g. fixed combination of sumatriptan and naproxen is superior to sumatriptan alone (Law et al, 2013).
Intransal application increases the efficacy: Zomig spray achieved 66% response rate compared to 35% rate of placebo (Dodick et al, 2005). Subcoutaneous sumatriptan is even better and achieves 70% response rate compare to 22% rate of placebo (Cady et al, 1991).
Lasmiditan, 5HT1F receptor agonist was superior to placebo with a therapeutic gain of about 40%, comparable with those of triptans (Färkkilä et al, 2012). CGRP Antagonists (Gepants) were studied in three different placebo controlled trials and were proved to be more effective than placebo but with a therapeutic gain again of about 30% and similar to zolmitriptan 5mg (Ho et al, 2008). In contrast, a well-known DHE orally inhaled had a robust response of 35% (minus placebo).
The review concludes that so far no new molecule was able to demonstrate superiority to existing 5HT agonists.
References:
1. Ferrari M, Roon K, Lipton RB, Goadsby P. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001 17; 358(9294): 1668-75.
2. Law S, Derry S, Moore RA. Sumatriptan plus naproxen for acute migraine attacks in adults. Cochrane Database Syst Rev. 2013 Oct 21;10.
3. Dodick D, Brandes J, Elkind A, Mathew N, Rodichok L. Speed of onset, efficacy and tolerability of zolmitriptan nasal spray in the acute treatment of migraine: a randomised, double-blind, placebo-controlled study. CNS Drugs. 2005;19(2):125-36.
4. Cady RK, Wendt JK, Kirchner JR, Sargent JD, Rothrock JF, Skaggs H. Treatment of acute migraine with subcutaneous sumatriptan. JAMA1991;265:2831–2835.
5. Färkkilä, M., Diener, H.C., Géraud, G., Láinez, M., Schoenen, J., Harner, N., Pilgrim, A., Reuter, U. For the COL MIG-202 studygroup. Efficacy and tolerability of lasmiditan, an oral 5- HT(1F) receptor agonist, for the acute treatment of migraine: a phase 2 randomised, placebo- controlled, parallel-group, dose-ranging study. Lancet Neurol., 2012, 11, 405-413.
6. Ho TW, Ferrari MD, Dodick DW, Galet V, Kost J, Fan X, Leibensperger H, Froman S, Assaid C, Lines C, Koppen H, Winner PK. Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial. Lancet. 2008 Dec 20;372(9656):2115-23.

Category: Neurology; Headache;