MedPath

Dihydroergotamine

Generic Name
Dihydroergotamine
Brand Names
Dhe-45, Migranal, Trudhesa
Drug Type
Small Molecule
Chemical Formula
C33H37N5O5
CAS Number
511-12-6
Unique Ingredient Identifier
436O5HM03C
Background

A 9,10alpha-dihydro derivative of ergotamine. Dihydroergotamine is used as an abortive therapy for migraines. Its use has largely been supplanted by triptans in current therapy due to the class's greater selectivity and more favourable side effect profile.

Recent improvements have been made in the design of intranasal delivery devices allowing for greater delivery of dihydroergotamine solution to the vasculature-rich upper nasal cavity. The recently approved Precision Olfactory Delivery technology developed by Impel Neuropharma technology has correlated with an increase of 3-fold in Cmax and 4-fold in AUC despite the solution formulated at 75% of the strength of the existing intranasal product.

Indication

Dihydroergotamine (DHE) in all formulations is indicated for the acute treatment of migraine with or without aura in adults. As an injection, DHE is also indicated for the acute treatment of cluster headache episodes.

DHE is not indicated for migraine prevention or the management of hemiplegic or basilar migraine.

Associated Conditions
Cluster Headache, Migraine Headache, With or Without Aura

Pulmatrix to Divest Phase 2-Ready Migraine Treatment and iSPERSE Technology Ahead of Cullgen Merger

• Pulmatrix plans to divest its clinical assets including PUR3100, a Phase 2-ready inhaled treatment for acute migraine, as part of its upcoming merger with Cullgen expected to close in June 2025. • The company's proprietary iSPERSE technology, which enables efficient pulmonary drug delivery with 146 granted patents, will also be divested as Pulmatrix transitions to focus on Cullgen's protein degradation platform. • First quarter 2025 financial results showed zero revenue (down from $5.9M in Q1 2024) with $7.7M cash on hand, which the company believes is sufficient to fund operations through the anticipated merger closing.

FDA Clears ZEISS INTRABEAM 700: Advanced Robotic-Assisted Platform for Intraoperative Radiotherapy

• ZEISS INTRABEAM 700 has received FDA 510(k) clearance, offering robotic-assisted precision for intraoperative radiation therapy in neuro-oncology and breast cancer treatment. • The platform features a digital-first architecture with SMART Workflow Efficiency, including sterile single-use applicators, intuitive controls, and Radiance™ treatment planning software for pre-operative simulation. • Currently being evaluated in multiple clinical trials including INTRAGO-II for glioblastoma and TARPIT-E for breast cancer, with results expected between 2025-2027.

Dupilumab Shows Strong Efficacy in Chronic Spontaneous Urticaria Across All BMI Ranges

• Phase 3 LIBERTY-CSU CUPID trials demonstrate dupilumab's effectiveness in reducing itch and urticaria activity in patients unresponsive to H1-antihistamines. • Clinical benefits of dupilumab were consistent across all BMI ranges, including patients in obese categories, providing important efficacy data for diverse patient populations. • FDA review of dupilumab for chronic spontaneous urticaria is underway with a target action date of April 18, 2025, potentially offering a new treatment option for resistant cases.

FDA Rejects Satsuma's STS101 Nasal Migraine Treatment Citing Manufacturing Issues

• The FDA issued a complete response letter for Satsuma Pharmaceuticals' STS101, a nasal powder formulation of dihydroergotamine mesylate (DHE), due to chemistry, manufacturing, and controls (CMC) issues. • STS101 aimed to offer a portable, easy-to-use option for acute migraine, potentially improving upon existing DHE nasal sprays like Bausch Health's Migranal. • The rejection positions Satsuma behind competitors like Impel Neuropharma (Trudhesa) and Pfizer (Zavzpret) in the crowded acute migraine treatment market. • Satsuma plans to meet with the FDA to determine the timeline for resubmitting the marketing application, emphasizing that clinical data was not a concern.

FDA Gears Up for Critical Decisions on Alzheimer's, Breast Cancer, and Neurological Therapies in Early 2025

• The FDA is set to decide on Biogen and Eisai's Leqembi for monthly intravenous maintenance in early Alzheimer's disease, potentially improving patient convenience. • AstraZeneca and Daiichi Sankyo await a decision on Dato-DXd for metastatic HR-positive, HER2-negative breast cancer, offering a new antibody-drug conjugate approach. • Vertex's suzetrigine, a non-opioid analgesic for moderate-to-severe acute pain, anticipates FDA verdict, representing a novel drug class for pain management. • SpringWorks' mirdametinib is under priority review for neurofibromatosis type 1-associated plexiform neurofibromas, addressing a significant unmet need.

Migraine Treatment Advances: CGRP Inhibitors, Digital Therapeutics, and Novel Compounds Highlight 2024

• The American Headache Society now recommends CGRP-targeting therapies as a first-line approach for migraine prevention, marking a significant shift in treatment strategy. • Nerivio, a remote electrical neuromodulation device, received FDA approval for expanded use in pediatric patients aged 8 and older for acute migraine treatment. • Clinical trials show promise for digital therapeutic CT-132 in reducing monthly migraine days, offering a novel non-pharmacological option for episodic migraine prevention.

FDA Accepts Satsuma and SNBL's NDA Resubmission for STS101 Migraine Treatment

• The FDA has accepted for review Satsuma Pharmaceuticals and SNBL's resubmitted NDA for STS101, a dihydroergotamine nasal powder, for acute migraine treatment. • The PDUFA date is set for April 30, 2025, offering hope for the nearly 40 million Americans suffering from migraine, especially women in their 20s to 40s. • STS101 is designed for quick self-administration, leveraging a proprietary nasal delivery device for rapid DHE absorption and sustained plasma concentrations. • The resubmission addresses FDA's previous concerns related to formulation, with no additional clinical trials requested, marking a significant step toward potential approval.

FDA Accepts Satsuma Pharmaceuticals' NDA for STS101 Migraine Treatment

• The FDA has accepted Satsuma Pharmaceuticals' 505(b)(2) NDA for STS101, a novel nasal powder formulation of dihydroergotamine mesylate (DHE) for acute migraine treatment. • STS101 is designed for easy self-administration and rapid achievement of high drug plasma levels, potentially offering advantages over existing DHE products. • The NDA is supported by Phase 1 and Phase 3 trial results, including the SUMMIT trial, which demonstrated robust and sustained effects on migraine endpoints. • Satsuma Pharmaceuticals is in the process of being acquired by Shin Nippon Biomedical Laboratories, Ltd. (SNBL).
© Copyright 2025. All Rights Reserved by MedPath