LY293558, a novel AMPA/GluR5 antagonist, is efficacious and well-tolerated in acute migraine.

Abstract

Glutamatergic hyperactivity is implicated migraine pathogenesis. Also, LY293558, an alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)/kainate (KA) receptor antagonist, is effective in preclinical models of migraine. We therefore tested LY293558 in acute migraine. We conducted a randomized, triple-blind, parallel-group, double-dummy, multicentre trial of 1.2 mg/kg intravenous (IV) LY293558, 6 mg subcutaneous (SC) sumatriptan, or placebo in the treatment of acute migraine. The primary efficacy variable was the headache response rate, i.e. headache score improvement from moderate/severe at baseline to mild/none at 2 h. Of 45 enrolled patients, 44 patients (20M:24F; mean age +/- SD = 40 +/- 9 years) completed the study. Response rates were 69% for LY293558 (P = 0.017 vs. placebo), 86% for sumatriptan (P < 0.01 vs. placebo) and 25% for placebo. LY293558 and sumatriptan were superior to placebo (P < 0.01 for all comparisons) on all other measures of improvement in pain and migraine associated symptoms. Fifteen percent of patients who took LY293558 reported adverse events (AEs) (n = 2; one mild, one severe). Fifty-three percent of patients who took sumatriptan (n = 8; seven mild, one moderate) and 31% of those who received placebo reported AEs (n = 5; four mild, one severe). The efficacy and safety results of LY293558 in this small migraine proof of concept trial, together with supportive preclinical data, provide evidence for a potential role of nonvasoactive AMPA/KA antagonists in treating migraine. Larger trials are needed to further test the hypothesis.

• Authors: C N Sang, N M Ramadan, R G Wallihan, A S Chappell, F G Freitag, T R Smith, S D Silberstein, K W Johnson, L A Phebus, D Bleakman, P L Ornstein, B Arnold, S J Tepper, F Vandenhende
• Journal: Cephalalgia : an international journal of headache (Cephalalgia) Vol. 24 Issue 7 Pg. 596-602 (Jul 2004) ISSN: 0333-1024 [Print] England
• PMID: 15196302 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Gluk1 kainate receptor
• Isoquinolines
• Receptors, AMPA
• Receptors, Kainic Acid
• Tetrazoles
• tezampanel

Topics

• Acute Disease
• Adult
• Analysis of Variance
• Chi-Square Distribution
• Female
• Humans
• Isoquinolines (pharmacology, therapeutic use)
• Male
• Middle Aged
• Migraine Disorders (drug therapy, metabolism)
• Receptors, AMPA (antagonists & inhibitors, metabolism)
• Receptors, Kainic Acid (antagonists & inhibitors, metabolism)
• Tetrazoles (pharmacology, therapeutic use)