Reacción a "New migraine drugs less effective than triptans, says meta-analysis"

As is well known, the optimal way to compare the efficacy of two drugs is called a double-blind randomised clinical trial, also known as head-to-head. I am not aware of any trial of a triptan versus a gepant or lasmiditan.

This article is a meta-analysis comparing placebo trials of triptans in the 1990s versus current trials of the new drugs.

The methodology has changed in these 20 years. In fact, the migraine criteria have changed (twice) and even the IHS [International Headache Society] migraine attack trial methodology guidelines have changed.
No one would think of comparing 20th century penicillin trials with today's amoxicillin trials in a particular infection.

It seems to me that, despite the statistics, it is very risky to conclude so strongly with the assertions made by the authors.

Opinion is one thing, science is another. Without a head-to-head trial of triptan vs. gepant or triptan vs. lasmiditan, we are unlikely to know which is more effective.

On the other hand, triptans are not effective in all patients and their therapeutic persistence at one year is low, so switching between them is common. Therefore, we need new drugs.
Finally, the IPT [Therapeutic Positioning Report] criteria for the National Health System (SNS) funding of lasmiditan position it as a failure, contraindication or adverse effect of triptans. As for the only gepant approved in Spain for migraine attacks, rimegepant, in the end it has not been funded by the SNS.

Therefore, we will continue to offer triptans to our patients as a first option for severe migraine attacks and anti-inflammatory drugs for moderate migraine attacks.
This meta-analysis changes absolutely nothing in Spain.