Lasmiditan, A Novel Abortive Agent for Migraine Therapy – From Triptans to Ditans

Abstract

Migraine is a neurological disorder and a common chronic primary headache disorder characterized by acute episodes of recurrent, unilateral, pulsating, throbbing headache. The migraine attack lasts for 4-72 hours associated with or without aura symptoms. According to global burden of diseases, migraine is the second leading cause of disability. Moreover, migraine is poorly managed by the currently available drugs implying that there is an unmet need for effective pharmacotherapeutics for this complex neurological disorder. Triptans are the gold standard drugs; however there are reports of migrainers who are not fully benefited. Moreover, triptans are not recommended in patients with cardiovascular risk factors due to peripheral vasoconstriction. Recently, lasmiditan, a highly selective 5-HT1F agonist, has been approved for the acute treatment of migraine with or without aura. Lasmiditan is the first in the new class of drugs 'ditans' which differ from the triptans in that these do not show vasoconstriction effect. Lasmiditan act on 5-HT1F receptors present on sensory neurons of trigeminal system without causing unwanted vasoconstriction due to its low affinity for 5-HT1B and 1D receptors. Lasmiditan is highly lipophilic and readily cross blood-brain-barrier, showed rapid absorption, and quick onset of action. In clinical trials, it had shown therapeutic effects and met the primary endpoints of headache pain freedom and most bothersome symptom freedom at 2 hours. Importantly, the efficacy of lasmiditan was not affected by the presence of cardiovascular risk factors in these clinical trials. Most frequently reported adverse drug reactions of lasmiditan are dizziness, sedation, somnolence, and paresthesia. Systematic reviews and meta-analysis data reported lasmiditan as safe and effective option for acute migraine treatment. However, long-term data on its use are required to establish safety and tolerability, effectiveness, and potential risk and drug-drug interactions between existing and novel antimigraine drugs in real world situation.Copyright © 2023, Global Research Online.