4.6 Article

The Neuropsychiatric Safety Profile of Lasmiditan: A Comparative Disproportionality Analysis with Triptans

Journal

NEUROTHERAPEUTICS
Volume 20, Issue 5, Pages 1305-1315

Publisher

SPRINGER
DOI: 10.1007/s13311-023-01404-1

Keywords

Migraine; Triptans; Lasmiditan; Neurological; Psychiatric; Safety; Pharmacovigilance

Ask authors/readers for more resources

Migraine is the second leading cause of disability worldwide. Triptans are the first-line treatment, although discouraged for use in high cardiovascular risk individuals. Lasmiditan, a selective 5-HT1F agonist, is a potential emerging option. A safety profile analysis comparing lasmiditan with triptans found that neurological and psychiatric disorders were disproportionally reported with lasmiditan, while adverse drug reaction classes were reported with triptans. Neuropsychiatric signals persisted more with triptans compared to lasmiditan. These findings suggest that lasmiditan may be a safe alternative for migraine treatment.
Migraine constitutes the world's second-leading cause of disability. Triptans, as serotonin 5-HT1B/1D receptor agonists, remain the first-line treatment, despite discouraged use in individuals at high cardiovascular risk. Lasmiditan, a selective lipophilic 5-HT1F agonist without vasoconstrictive effects, is an emerging option. We aimed to investigate the safety profile of lasmiditan in the WHO pharmacovigilance database (VigiBase(& REG;)) using a comparative disproportionality analysis with triptans. VigiBase(& REG;) was queried for all reports involving lasmiditan and triptans. Disproportionality analyses relied on the calculation of the information component (IC), for which 95% confidence interval (CI) lower bound positivity was required for signal detection. We obtained 826 reports involving lasmiditan. Overall, 10 adverse drug reaction classes were disproportionately reported with triptans, while only neurological (IC 1.6; 95% CI 1.5-1.7) and psychiatric (IC 1.5; 95% CI 1.3-1.7) disorders were disproportionately reported with lasmiditan. Sedation, serotonin syndrome, euphoric mood, and autoscopy had the strongest signals. When compared with triptans, 19 out of 22 neuropsychiatric signals persisted. The results of our analysis provide a more precise semiology of the neuropsychiatric effects of lasmiditan, with symptoms such as autoscopy and panic attacks. The cardiovascular adverse drug reaction risk with triptans was confirmed. In contrast, caution is warranted with lasmiditan use in patients with neurological or psychiatric comorbidities or serotonin syndrome risk. Our study was hindered by pharmacovigilance flaws, and further studies should help in validating these results. Our findings suggest that lasmiditan is a safe alternative for migraine treatment, especially when the neuropsychiatric risk is outweighed by the cardiovascular burden.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available