title: 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.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: C N
authors.initials: CN
authors.lastname: Sang
authors.forename: N M
authors.initials: NM
authors.lastname: Ramadan
authors.forename: R G
authors.initials: RG
authors.lastname: Wallihan
authors.forename: A S
authors.initials: AS
authors.lastname: Chappell
authors.forename: F G
authors.initials: FG
authors.lastname: Freitag
authors.forename: T R
authors.initials: TR
authors.lastname: Smith
authors.forename: S D
authors.initials: SD
authors.lastname: Silberstein
authors.forename: K W
authors.initials: KW
authors.lastname: Johnson
authors.forename: L A
authors.initials: LA
authors.lastname: Phebus
authors.forename: D
authors.initials: D
authors.lastname: Bleakman
authors.forename: P L
authors.initials: PL
authors.lastname: Ornstein
authors.forename: B
authors.initials: B
authors.lastname: Arnold
authors.forename: S J
authors.initials: SJ
authors.lastname: Tepper
authors.forename: F
authors.initials: F
authors.lastname: Vandenhende
mesh_terms: D000208:Acute Disease; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000378:metabolism; D018091:Receptors, AMPA / Q000037:antagonists & inhibitors* / Q000378:metabolism; D018092:Kainic Acid Receptors / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D007546:Isoquinolines; D018091:Receptors, AMPA; D018092:Kainic Acid Receptors; D013777:Tetrazoles; C082309:tezampanel