Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark.
School of Health, Unitelma Sapienza University of Rome, Rome, Italy.
J Headache Pain. 2024 Aug 22;25(1):137. doi: 10.1186/s10194-024-01841-z.
This commentary addresses the use of rimegepant for situational prevention in migraine management. While the approach of using prophylactic treatments during high-risk periods is not new, its application with rimegepant described by Lipton et al. raises ethical and clinical concerns. These include the challenge of defining high-risk periods, the potential for overmedication, and the risk of medication overuse headache (MOH). The current evidence on MOH with gepants is inconclusive, and recommendations on dosing may be insufficient. Additionally, the long-term safety of calcitonin gene-related peptide (CGRP) antagonists remains uncertain, especially regarding cardiovascular and other systemic effects. The commentary emphasizes the need for caution and thorough investigation into the long-term risks and benefits of situational prevention with rimegepant before widespread adoption.
本评论探讨了利扎曲普坦用于偏头痛管理中的情境预防。虽然在高危期使用预防性治疗的方法并不新鲜，但利普顿等人描述的利扎曲普坦的应用引发了伦理和临床方面的关注。这些问题包括界定高危期的挑战、过度用药的可能性以及药物过度使用性头痛（MOH）的风险。目前关于 gepants 引起的 MOH 的证据尚无定论，且关于剂量的建议可能也不充分。此外，降钙素基因相关肽（CGRP）拮抗剂的长期安全性仍不确定，尤其是涉及心血管和其他全身作用。该评论强调，在广泛采用利扎曲普坦进行情境预防之前，需要谨慎并深入研究其长期风险和益处。
