Ubrelvy vs Imitrex (sumatriptan): How do they compare?

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Ubrelvy and Imitrex are both oral tablets used to treat migraine, but there are differences in the way they work. Ubrelvy prevents a protein called CGRP thought to play a role in migraine attacks from binding to its receptor and Imitrex is thought to bind to serotonin 5‑HT1B/1D receptors, and inhibit pro-inflammatory substances. Although no head-to-head comparison trials compare Ubrelvy to Imitrex (sumatriptan), indirect evidence suggests that overall, Ubrelvy is no more effective, and may be inferior to Imitrex at relieving migraine in adults who are able to tolerate triptans. For those adults with moderate-to-severe migraine attacks that cannot tolerate triptans or who have found them ineffective, Ubrelvy is beneficial for treating migraines compared to no treatment. Ubrelvy is associated with fewer side effects than Imitrex, but is more expensive, costing almost twice as much.

Ubrelvy can be given together with Imitrex to treat the same migraine event and this combination is well tolerated. Pharmacokinetic research shows slight alterations in pharmacokinetic parameters such as time to maximum concentration, and mean maximum plasma concentration, but these are not considered clinically relevant.

Ubrelvy Vs Imitrex (sumatriptan): How do they work?

Ubrelvy belongs to the class of medicines known as CGRP inhibitors. CGRP stands for calcitonin gene-related peptide (CGRP) receptor antagonists (also known as gepants) and Ubrelvy works by preventing CGRP from attaching to CGRP receptors on nerve endings. CGRP is a protein that is thought to play a role in migraine attacks by causing pain, dilation of blood vessels, and inflammation. By preventing CGRP from binding to its receptor, Ubrelvy stops migraine pain and other symptoms.

Imitrex (sumatriptan) belongs to the class of medicines known as Triptans, and are thought to work by binding to serotonin 5‑HT1B/1D receptors, inhibiting pro-inflammatory substances, and constricting cranial blood vessels. Imitrex works in a different way to CGRP inhibitors, such as Ubrelvy.

Are there any trials that compare Ubrelvy with Imitrex (sumatriptan)

Head-to-head trials comparing Ubrelvy with sumatriptan are lacking. However, indirect evidence suggests:

  • That triptans are similar or more effective than lasmiditan, rimegepant, and ubrogepant (Ubrelvy)
  • All 3 agents (lasmiditan, rimegepant and ubrogepant [Ubrelvy]) showed lower odds of achieving pain freedom or pain relief at 2 hours after dose compared with eletriptan or sumatriptan.
  • There were no statistically significant differences on any measure of patient benefit between triptans and lasmiditan, rimegepant, or ubrogepant (Ubrelvy)
  • These new agents provide an option for patients with absolute or relative contraindications to triptans
  • Ubrogepant (Ubrelvy) was twice more expensive than sumatriptan
  • In the analysis of triptan-eligible patients, sumatriptan and eletriptan produced higher quality of life scores at a lower total cost and dominated all 3 novel agents
  • Overall rates of discontinuation were considerably lower in the ubrogepant (2.7%) and rimegepant (2.7%) group.

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