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

Cephalalgia. 2004 Jul;24(7):596-602. doi: 10.1111/j.1468-2982.2004.00723.x.

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

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