| アブストラクト | Migraine constitutes the world's second-leading cause of disability. Triptans, as serotonin 5-HT(1B/1D) receptor agonists, remain the first-line treatment, despite discouraged use in individuals at high cardiovascular risk. Lasmiditan, a selective lipophilic 5-HT(1F) agonist without vasoconstrictive effects, is an emerging option. We aimed to investigate the safety profile of lasmiditan in the WHO pharmacovigilance database (VigiBase((R))) using a comparative disproportionality analysis with triptans. VigiBase((R)) 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. |
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| ジャーナル名 | Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics |
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| 投稿日 | 2023/7/12 |
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| 投稿者 | Merino, Diane; Gerard, Alexandre O; Van Obberghen, Elise K; Destere, Alexandre; Lanteri-Minet, Michel; Drici, Milou-Daniel |
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| 組織名 | Department of Psychiatry, Universite Cote d'Azur, University Hospital of Nice,;Nice, France.;Department of Pharmacology and Pharmacovigilance Center of Nice, Universite Cote;d'Azur, University Hospital of Nice, Nice, France.;Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, Universite Cote d'Azur,;CNRS, Nice, France.;Department and FHU InovPain, Universite Cote d'Azur, University Hospital of Nice,;Laboratoire J.A. Dieudonne, Universite Cote d'Azur, Inria, CNRS, Maasai Team,;UMR 1107, Migraine and Trigeminal Pain, INSERM, Auvergne University,;Clermont-Ferrand, France.;d'Azur, University Hospital of Nice, Nice, France. pharmacovigilance@chu-nice.fr. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/37436579/ |
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