Efficacy of lasmiditan for the acute treatment of perimenstrual migraine

E Anne MacGregor, Mika Komori, John Henry Krege, Simin Baygani, Maurice Vincent, Jelena Pavlovic, Hisaka Igarashi, E Anne MacGregor, Mika Komori, John Henry Krege, Simin Baygani, Maurice Vincent, Jelena Pavlovic, Hisaka Igarashi

Abstract

Background: Perimenstrual migraine attacks in women with menstrual migraine is difficult to treat. This post-hoc analysis evaluated the efficacy of lasmiditan, a high affinity and selective 5-HT1F receptor agonist, for perimenstrual attacks.

Methods: Patients from two randomized, double-blind, placebo-controlled clinical trials (MONONOFU and CENTURION) were instructed to treat an attack with a single dose of study medication within four hours of pain onset. After dosing, the proportion of patients who achieved freedom from migraine-related head pain, most bothersome symptom, and disability was reported at baseline up to 48 hours after dose and pooled data were evaluated.

Results: A total of 303 patients (MONONOFU N = 78; CENTURION N = 225) treated perimenstrual migraine attacks with lasmiditan 50 mg (N = 24), 100 mg (N = 90), 200 mg (N = 110), and placebo (N = 79). More patients achieved migraine-related head pain freedom with lasmiditan 200 mg versus placebo at all time points assessed. At 2 hours, 33.6% of patients in the 200-mg group (p < 0.001), and 16.7% of patients in the 100-mg (p = 0.11) and 50-mg (p = 0.19) groups were pain free, compared with 7.6% in the placebo group.

Conclusions: Lasmiditan treatment of perimenstrual migraine attacks was associated with freedom from migraine-related head pain at two hours, early onset of efficacy, and sustained efficacy.Clinical Trial registration: NCT03962738 and NCT03670810.

Keywords: Acute treatment; lasmiditan; menstrual migraine; migraine attack; most bothersome symptom; pain freedom; pain relief; perimenstrual.

Figures

Figure 1.
Figure 1.
Proportion of patients with pain freedom among women treating attack during perimenstrual attack.
Figure 2.
Figure 2.
Proportion of attacks with pain freedom in women who treated at least 1 perimenstrual migraine attack vs women who treated at least one non-perimenstrual migraine attack. Note: Solid lines correspond to women who treated perimenstrual migraine attacks and dotted lines correspond to women who treated non-perimenstrual migraine attacks.

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