The cardiovascular adverse effects of triptans – described as their ‘Achilles’ heel’ – led to the development of the ditans (selective serotonin receptor 1F agonists).[González-Hernández et al., 2018] Ditans appear to lack the strong vasoconstrictor effects seen with triptan therapy, and have a cardiovascular safety advantage over the triptans.[González-Hernández et al., 2018] Indeed, the fact that ditans are effective in treating headache, despite the apparent lack of vasoconstriction, has led some to question the role of vasoconstriction in the mechanism of action of triptans and ditans.[Do et al., 2019]
References:
Do TP, Guo S, Ashina M. Therapeutic novelties in migraine: new drugs, new hope? J Headache Pain 2019; 20 (1): 37.
González-Hernández A, Marichal-Cancino BA, Maassen Van Den Brink A, Villalón CM. Side effects associated with current and prospective antimigraine pharmacotherapies. Expert Opin Drug Metab Toxicol 2018; 14 (1): 25–41.
Other references used on slide:
American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache 2019; 59 (1): 1–18.
Eigenbrodt, AK, Ashina H, Khan S, Diener HC, Mitsikostas D, Sinclair AJ, … & Ashina M. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021, 17(8): 501-514.
U.S. Food & Drug Administration. Accessed October 2022.
Kuca B, Silberstein SD, Wietecha L et al Lasmiditan is an effective acute treatment for migraine: a Phase 3 randomized study. Neurology 2018; 91 (24): e2222–e2232.
Shapiro RE, Hochstetler HM, Dennehy EB, et al. Lasmiditan for acute treatment of migraine in patients with cardiovascular risk factors: post-hoc analysis of pooled results from 2 randomized, double-blind, placebo-controlled, Phase 3 trials. J Headache Pain 2019; 20 (1): 90.
Xavier AS, Lakshmanan M, Gunaseelan V. The journey of the non-vascular relief for migraine: from ‘triptans’ To ‘ditans’. Curr Clin Pharmacol 2017; 12 (1): 36–40.
