Reacción a "New migraine drugs less effective than triptans, says meta-analysis"

Although meta-analysis is considered to be the highest degree of evidence possible, its interpretation should be cautious, as this is true when the studies included are truly comparable. In the present case, the large number of studies, from different dates and with different ways of assessing the outcome, partly limits its quality, although it is a conscientious and methodologically robust work.

The main novelty is the comparison of ‘new’ treatments for acute migraine attacks with previously existing options, i.e. gepants and lasmiditan versus triptans, anti-inflammatory drugs and paracetamol, respectively.
Considering the individual results of the clinical trials of the ‘new’ treatments, where the published results were already somewhat inferior to those presented when the evidence for the new treatments was generated, this does not come as a great surprise.

In the field of migraine, what patients are looking for is for their attacks to go away quickly, without side effects and without the pain returning within 24 hours. What the results of this work show is that the ‘classic’ drugs seem to have a higher probability of response than the new ones, although the frequency with which patients experience side effects is also higher. In addition, some ‘classical’ drugs may pose a certain risk in certain patients and should be avoided in these patients.

This work reinforces the idea that the treatment of people with migraine and other headaches should be personalised and tailored to the individual patient. Traditional drugs are of great help if they are used appropriately, which is not always the case, and fortunately we now have new tools that can help people who have not benefited sufficiently or who were excluded from these therapies because they have other illnesses or cannot tolerate them adequately.

[Regarding possible limitations] In this work the type of comparison performed is indirect, using network meta-analysis, where the main comparison is based on the difference from the placebo group in each study. It would be expected, therefore, that the placebo response rate would be very similar in all studies, both in measures of efficacy and tolerability, and across studies the outcome was variable.