CONy 2022 | Do triptans demonstrate better efficacy and/or tolerability than ditans or gepants?

Bojana Žvan, MD, PhD, University Medical Center Ljubljana, Ljubljana, Slovenia, compares the efficacy, tolerability, and safety of triptans to ditans and gepants for the acute treatment of migraine. Triptans are selective serotonin 5-HT1B/1D receptor agonists and are regarded as the standard of care for treating acute migraine. However, evidence has depicted an unsatisfactory response to existing triptans, with approximately only 30% of patients being pain-free after two hours from treatment and a discontinuation rate of 55-80%. Additionally, triptans target the 5-HT1B receptors, which can mediate a vasoconstrictor effect and are therefore contraindicated in patients with hypertension and cardiovascular diseases. The development of serotonin agonists without vasoconstriction properties like the ditans, specific 5HT1F receptor agonists, demonstrates a promising alternative. Furthermore, Prof. Žvan describes how two large studies, SAMURAI (NCT02439320) and SPARTAN (NCT02605174), have shown high efficacy and low rates of adverse side effects from lasmiditan. Finally, gepants, small molecules that block the CGRP docking station or CGRP receptor and do not cause vasoconstriction, have been shown to be very effective in the acute treatment of migraine. This interview was conducted during the 2022 World Congress on Controversies in Neurology (CONy) meeting.