Sheena Aurora, MD, medical fellow and global launch leader, Eli Lilly and Company, Indianapolis.
Bottom Line: Promising new drug relieves migraine without putting your life at risk.
Yes, there are medications for migraine. Unfortunately, they don’t always completely relieve the symptoms…can take a long time to work…and cause side effects, including serious ones such as high blood pressure and increased risk for heart attack. Now a new drug—and the first in a new class of migraine drug in nearly 20 years—that promises safer, faster relief for this debilitating condition may soon be available.
Triptans have long been the go-to drug for acute treatment of migraine symptoms once they start. These drugs—such assumatriptan (Imitrex), zolmitriptan (Zomig) and others—work by helping serotonin bind to sites in the brain called 5-HT receptors. Serotonin constricts blood vessels, and constricting blood vessels in the brain helps relieve migraine pain. Unfortunately, triptans constrict other blood vessels outside the brain, too, including heart vessels, which can cause chest pain, high blood pressure…and lead to heart attack.
The new drug, lasmiditan, also binds to 5-HT receptors—but only to those in the brain that are involved in migraine attacks. So the drug does not affect the heart or blood pressure. Lasmiditan is also very fast and effective—providing complete relief in as short a time as one hour.
Two clinical trials compared taking lasmiditan with a placebo among close to 4,500 people (average age 42) who reported three to eight debilitating migraines per month. Some but not all the participants had migraine aura, and most in both studies also had some risk factors for heart disease—and one study included people with known heart disease, arrhythmias and/or high blood pressure. The studies were conducted by Eli Lilly, the company that makes the drug, and the results were presented at the annual meeting of the American Headache Society in San Francisco.
Results: For migraineurs who took 200 milligrams (mg) of lasmiditan within four hours of a migraine attack, 32% in one study and 39% in the other were pain free—compared with 15% and 21% who took the placebo. Photophobia (pain associated with light) was about 41% to 49% relieved, compared with 30% to 33% for placebo. And even though they may not have had complete pain relief, 60% to 65% reported some pain relief, compared with 40% in the placebo group. (The researchers did not compare lasmiditan with triptans.)
Best: Cardiovascular side effects were not reported, even among migraineurs with known heart problems and/or high blood pressure. The most common side effects were mild-to-moderate dizziness, tingling or numbness, sleepiness, fatigue and nausea.
Lasmiditan is not yet available to the public, but Eli Lilly hopes to be seeking FDA approval by the end of 2018. Meanwhile, let your doctor know if you are interested in trying the drug so that he/she can let you know as soon as it is available.