Presentation (CTI)

OBJECTIVES: Sumatriptan, a widely used treatment for acute migraines, is contraindicated in patients with cardiovascular conditions due to its vasoconstrictive properties. Since 2020, newer migraine-specific treatments, including ubrogepant, rimegepant, and lasmiditan, have provided alternative options that do not cause vasoconstriction. However, evidence comparing the cardiovascular risks across the newer treatments is currently limited. This study aimed to compare the risk of major adverse cardiovascular events (MACE) among patients treated with ubrogepant, rimegepant, and lasmiditan versus those treated with sumatriptan.
METHODS: We used a retrospective cohort study design using a large administrative database from 2016-2023. The outcome of interest was three-point MACE (acute myocardial infarction, stroke, and cardiovascular death). Baseline characteristics including patient characteristics, index year, type of migraine, migraine-related medications, and Charlson comorbidity index were used to create propensity scores. Propensity score matching was used to minimize confounding in pairwise comparisons. Time to MACE was assessed in pairwise comparisons using Cox proportional hazards models. Patients were censored if they experienced all cause death, treatment discontinuation, end of insurance coverage, or end of study (December 31, 2023), whichever came first.
RESULTS: After propensity score matching, three comparison cohorts were created: ubrogepant vs. sumatriptan (n=2,834 each), rimegepant vs. sumatriptan (n=2,710 each), and lasmiditan vs. sumatriptan (n=165 vs. 330, matched at 1:2 ratio). The HRs of MACE were 0.55 (95% CI 0.43-0.70) for ubrogepant vs. sumatriptan, 0.55 (95% CI 0.44-0.69) for rimegepant vs. sumatriptan, and 1.08 (95% CI 0.57-2.08) for lasmiditan vs. sumatriptan.
CONCLUSIONS: Our study found that ubrogepant and rimegepant were associated with a lower risk of MACE compared to sumatriptan highlighting their potential as safer alternatives for patients with cardiovascular risk. No significant difference in MACE risk was observed between lasmiditan and sumatriptan suggesting the need for further research to better understand the cardiovascular safety profile of lasmiditan.