Mechanism of Action:
- Ditans are selective 5-HT1F receptor agonists.
- Unlike triptans, they do not cause vasoconstriction due to the absence of 5-HT1B/1D receptors on blood vessels.
- Rationale: The 5-HT1F receptor is located in the central and peripheral nervous system, not on vasculature, avoiding vascular side effects.
- Clinical Efficacy:
- Lazertibant (first FDA-approved ditan) demonstrated superiority over placebo in phase 3 trials for acute migraine treatment.
- Rationale: Efficacy was established in large, randomized controlled trials (RCTs) with statistically significant pain freedom and pain relief at 2 hours.
- Adverse Effects:
- Generally well-tolerated; common side effects include paresthesia, dizziness, and nausea.
- Rationale: Lack of vasoconstrictive properties reduces cardiovascular risks seen with triptans.
- Role in Therapy:
- Preferred for patients with cardiovascular risk factors or contraindications to triptans.
- Rationale: Avoids vasoconstriction-related complications (e.g., coronary artery spasm).
- Key Differences from Triptans:
- No vascular effects, broader therapeutic window, and potential for better tolerability.
- Rationale: 5-HT1F receptor activation may modulate pain pathways without vascular changes.