Lasmiditan: an additional therapeutic option for the acute treatment of migraine

ABSTRACT

Introduction: Migraine is currently listed as the second cause of ‘years lived with disability’ and the sixth cause of global disability. Despite the burden associated to the disease, availability of specific drugs is still limited.

Areas covered: The authors have evaluated lasmiditan, the first ‘ditan’ approved by the Food and Drugs Administration in 2019, from a global perspective: basic chemistry, pharmacodynamic and pharmacokinetic profiles, efficacy in migraine as a 5-HT_1F receptor selective agonist, tolerability and clinical safety, and impact on migraine-related disability. Our evaluation considered original papers and review articles published from 2010 to 2020.

Expert opinion: Available data point to the efficacy of lasmiditan in reducing migraine pain and the most bothersome symptoms within 2 hours from oral administration. Moreover, lasmiditan has a positive effect on migraine-related disability. Its side effects mostly reflect an involvement of the central nervous system or the vestibular system, while cardiovascular side effects are rare and mild.

Lasmiditan can be safely prescribed in patients who have failed non-steroid anti-inflammatory drugs or triptans or with cardiovascular risk factors. Caution is advised in frequent users, due to lack of reliable data on its abuse potential. Further data are necessary to determine the usability of lasmiditan in particular populations, e.g. children and adolescents, pregnancy.

KEYWORDS:

• Headache
• migraine
• acute treatment
• ditans
• 5HT_1F agonism
• lasmiditan
• triptans
• cardiovascular risk
• most bothering symptom
• side effects
• dizziness
• disability

Article highlights

• Migraine is a complex disorder that involves multiple brain regions and metabolic pathways, associated with high disability.

• Despite the severe disability associated with the disease, specific treatments are very limited.

• Ditans are pure 5-HT_1F agonists, with a minimal effect on other 5-HT₁ receptors, devoid of vasoconstrictive activity.

• Lasmiditan proved effective in reducing migraine pain within 2 hours from its administration. It also reduced the intensity of the most bothersome symptom associated with migraine and migraine-related disability.

• Lasmiditan has a very good cardiovascular tolerability. Side effects associated with the Central Nervous System, though not severe, can be discomforting and impair activity.

• Driving a motor vehicle or operating machinery should be avoided for at least 8 hours after each dose.

• Lasmiditan has been approved by FDA, not yet by EMA.

• Lasmiditan has proved useful for a wide variety of migraine patients, including those with cardiovascular risk factors.

• Low drug abuse potential has been reported, thus special precautions need to be put in place to prevent medication overuse.

Declaration of interest

C Tassorelli reports speaker’s or advisory board’s fees from Eli Lilly, Novartis, TEVA and Allergan and institutional payments for clinical trials with Eli Lilly. They have no ownership interest and does not own stocks of any pharmaceutical company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.