Ditans: a new prospective for the therapy of migraine attack?

• Published in: Neurological sciences Vol. 43; no. 9; pp. 5709 - 5716
• Main Authors: Viticchi, Giovanna, Falsetti, Lorenzo, Silvestrini, Mauro, Bartolini, Marco
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2022; Springer Nature B.V
• Subjects: Adverse events; Agonists; Clinical trials; Double-blind studies; Drowsiness; Headache; Medicine; Medicine & Public Health; Migraine; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Pain; Psychiatry; Review Article; Serotonin S1 receptors; Vascular diseases; Vertigo; Ditans; Lasmiditan; Migraine; 5-HT1F agonists
• ISSN: 1590-1874; 1590-3478; 1590-3478
• DOI: 10.1007/s10072-022-06260-z

Introduction Migraine attack is characterized by disabling pain and associated symptoms. Triptans represent the “gold standard” therapy, but cardiac subjects have significant limitations for this approach. New drug families are under consideration to expand therapeutic offerings, especially in the presence of contraindications or for non-responsive patients. This review aimed to analyze studies related to the category of “ditans,” with a focus on lasmiditan, which is available for human use. Materials and methods We consulted PubMed/MEDLINE, Web of Science, and www.clinicaltrials.gov to find both original and review articles on the mechanism of action of 5-HT1F agonists in migraine, and for randomized, double-blind, placebo-controlled trials (RCTs) on the family of drugs called “ditans,” with a focus on “lasmiditan,” published in the time frame of 01-Jan-2010 to 31-Mar-2022. Only studies conducted in human subjects and published in English were included in this review. Results We retrieved four RCTs (named SAMURAI, SPARTAN, GLADIATOR, and CENTURION) and several studies that analyzed the efficacy and safety of lasmiditan. Lasmiditan at increasing doses showed significant improvement in pain and most other troublesome symptoms at 2 h. Adverse events were mild and mainly represented by dizziness, vertigo, drowsiness, and fatigue. No vasoconstrictive effects were described, suggesting the use of ditans as a safe option in chronic cardio- and cerebro-vascular disease. Discussion Lasmiditan could be a viable alternative to triptans, although further RCT studies and real-world evidence are needed to better understand its potential and possible adverse events in a larger population.