Examining Lasmiditan for the Acute Treatment of Migraine Compared With Triptans

Headache is extremely common in the general population, but despite its high prevalence and impairment, migraine is often not recognized or effectively treated.¹ 

Per the American Migraine foundation, oral and intranasal triptan therapy has proven consistently effective when used to treat migraine earlier in the attack—particularly when the attack is still mild to moderate.²

However, triptan therapy is not effective for all patients with migraine and cannot prevent or stop every headache, prompting the need for other treatment options. In those cases, lasmiditan has demonstrated superiority to placebo in the acute treatment of migraine in adults with moderate/severe migraine disability in two similarly designed Phase 3 trials, SAMURAI and SPARTAN. Post-hoc integrated analyses evaluated the efficacy of lasmiditan in patients who reported a good or insufficient response to triptans and in those who were triptan naïve.³

In the SPARTAN trial, two patient subgroups were identified; the first group reported an overall response of "good" or "poor/none" to the most recent use of a triptan at baseline (defined as good or insufficient responders, respectively) and the second was a triptan-naïve subpopulation derived from combined study participants randomized to receive lasmiditan 50 mg (SPARTAN only), 100 mg or 200 mg, or placebo, as the first dose.³

Primary outcome measures such as headache pain-freedom, most bothersome symptom-freedom, and headache pain relief 2 hours post-first dose of lasmiditan were compared with placebo. Researchers also investigated whether therapeutic benefit varied according to prior triptan response (good or insufficient).³

Per the results of the study, lasmiditan demonstrated higher efficacy than placebo, regardless of triptan respond. Futher, treatment-by-subgroup analyses found that the benefit over placebo of lasmiditan did not vary significantly between patients with a good response and those with an insufficient response to triptans. Lasmiditan also showed higher efficacy than placebo in triptan-naïve patients.³

According to another study, conducted by Mecklenburg and colleagues, “Lasmiditan is a promising acute anti-migraine therapy, in particular for patients with cardiovascular risk factors, contraindications, or unwanted side effects to triptans.”⁴

This study further demonstrated that patients using Lasmiditan achieved headache freedom while also reducing photophobia—one of the most commonly reported bothersome symptoms. 

“For those people with migraine who are not able to take triptans, results from clinical trials show that lasmiditan, rimegepant, and ubrogepant all decrease symptoms of migraine attacks and improve function compared with placebo,” stated the Institute for Clinical and Economic Review in a report on acute treatments for migraine.⁵ 

References: 

1. AMCP. Summit on the Future Treatments in Migraine and Cluster Headaches: Findings from the AMCP Market Insights Program [published online April 2020]. https://www.amcp.orghttps://s3.amazonaws.com/HMP/hmp_ln/imported/2020-04/MarketInsightMigraines_April2020.pdf. Accessed February 9, 2021.
2. American Migraine Foundation. Oral Triptan Therapy [published June 2, 2006]. https://americanmigrainefoundation.org/resource-library/oral-triptan-therapy. Accessed February 9, 2021
3. Knievel K, Buchanan AS, Lombard L, et al. Lasmiditan for the acute treatment of migraine: Subgroup analyses by prior response to triptans. Cephalalgia. 2020 Jan;40(1):19-27. doi:10.1177/0333102419889350. 
4. Mecklenburg J, Raffaelli B, Neeb L, Sanchez Del Rio M, Reuter U. The potential of lasmiditan in migraine. Ther Adv Neurol Disord. 2020 Oct 21;13:1756286420967847. doi: 10.1177/1756286420967847.
5. Institute for Clinical and Economic Review. ICER Releases Evidence Report on Acute Treatments for Migraine [press release published January 10, 2020]. https://icer.org/news-insights/press-releases/acute_migraine_evidence_report. Accessed February 8, 2021.