New migraine drugs less effective than older triptan meds: BMJ study

A recent meta-analysis involving 137 clinical trials has revealed that the latest class of migraine medications is less effective in alleviating acute headaches compared to the older generation of triptan drugs. The study, published by The BMJ, highlights that new treatments, including Pfizer’s Nurtec, AbbVie’s Ubrelvy, and Eli Lilly’s Reyvow, fall short in comparison to their predecessors in the acute management of migraines.

The comprehensive analysis, which spanned nearly 90,000 participants, concludes that triptans remain the most effective option for migraine relief. Among the 17 drugs evaluated, triptans exhibited superior efficacy within two hours of administration. Eletriptan, marketed by Pfizer as Relpax since 2002, emerged as the top performer, providing the best-sustained relief over 24 and 48 hours. Other notable triptans that followed in effectiveness were rizatriptan (sold as Maxalt by Organon), sumatriptan (marketed as Imitrex by GSK), and zolmitriptan (sold as Zomig by AstraZeneca).

The study authors emphasize that triptans are significantly underutilized and advocate for improved global access and updated international guidelines to reflect these findings. They suggest that the most effective triptans should be more widely promoted and accessible to patients worldwide.

Furthermore, the analysis indicates that newer migraine drugs, which belong to a class known as calcitonin gene-related peptide receptor (CGRP) antagonists, should be considered only after traditional headache medications have been tried. These newer options, such as lasmiditan (Reyvow), rimegepant (Nurtec), and ubrogepant (Ubrelvy), come with a high cost and notable adverse effects, especially with lasmiditan, making them less favorable as first-line treatments.

While the study primarily focused on the acute treatment of migraines, it is worth noting that some CGRP treatments have also been approved for preventive use. For instance, Nurtec received approval in 2021 for prophylactic use, with patients advised to take the medication every other day to prevent migraines.

Despite the study’s findings, there remains significant interest and investment in CGRP drugs. Pfizer, for example, spent $11.6 billion to acquire Biohaven and gain access to Nurtec, which achieved $928 million in sales last year. Ubrelvy, approved in 2019, also saw substantial sales, amounting to $815 million.

Additionally, several other CGRP drugs, approved in 2018 for migraine prevention, continue to hold strong positions in the market. Eli Lilly’s Emgality generated $678 million in sales last year, Teva’s Ajovy pulled in $435 million, and Amgen’s Aimovig collected $303 million. Another CGRP drug, Lundbeck's Vyepti, approved in 2020, generated approximately $250 million last year.

In summary, the meta-analysis underscores the superior efficacy of triptan drugs over newer migraine treatments in managing acute headaches. It calls for a reevaluation of current treatment guidelines to prioritize the use of triptans and suggests that CGRP antagonists be reserved as third-line options due to their higher costs and associated side effects.