DHE - past, present, and future: a narrative review

Area of Science:

• Neurology
• Pharmacology
• Drug Delivery Systems

Background:

• Dihydroergotamine (DHE) has been a staple for acute migraine treatment since its 1946 approval, primarily via intravenous injection.
• The enduring efficacy of intravenous DHE in migraine management necessitates exploring alternative delivery methods.
• Recent advancements focus on inhalational DHE formulations for improved patient convenience and rapid symptom relief.

Purpose of the Study:

• To review DHE development programs for novel migraine treatments.
• To assess various DHE delivery approaches for efficacy, speed, and convenience.
• To explore potential repurposing of DHE for other medical indications.

Main Methods:

• Narrative review of DHE development programs, including successful and failed attempts.
• Analysis of nasal and pulmonary DHE delivery systems.
• Examination of DHE's historical and current therapeutic applications.

Main Results:

• Three new DHE nasal products have received FDA approval within the last five years.
• Pulmonary DHE delivery systems are in clinical development for optimizing at-home migraine treatment.
• DHE has been investigated for potential repurposing in other indications.

Conclusions:

• Novel DHE formulations, particularly nasal and pulmonary, show promise for needle-free, at-home migraine relief.
• Continued development aims to enhance efficacy, speed, and convenience of DHE migraine therapy.
• DHE's therapeutic potential extends beyond migraine, with ongoing research into repurposing.