Atogepant superior to rimegepant in reducing monthly migraine days at 12 weeks
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Key takeaways:
- Atogepant and rimegepant displayed similar safety and tolerability profiles in patients with migraine.
- Atogepant showed greater reduction in acute medication use days compared with rimegepant.
Treatment with atogepant 60mg once daily significantly reduced monthly migraine days at 12 weeks compared with oral rimegepant 75mg every other day, according to research published in Cephalalgia.
“Atogepant and rimegepant are oral, small-molecule [calcitonin gene-related peptide] receptor agonists used for the preventive treatment of migraine,” Cristina Tassorelli, MD, PhD, a professor of neurology in the department of brain and behavioral sciences at the University of Pavia in Italy, and colleagues wrote. “Atogepant is indicated for the preventive treatment of episodic migraine and chronic migraine, while rimegepant is indicated for EM and as an acute migraine treatment.”
Tassorelli and colleagues sought to examine safety, efficacy and tolerability of these preventive migraine treatments to add to the body of knowledge that informs clinical decision-making for migraine management.
They pooled data for an anchored matching-adjusted indirect comparison analysis from a pair of phase 3 atogepant (Qulipta, Abbvie) trials (ADVANCE and PROGRESS) and one phase 2/3 rimegepant (Nurtec ODT, Pfizer) trial.
A total of 252 participants were included in efficacy analysis and 259 for safety and tolerability among those receiving atogepant 60mg once daily. The rimegepant group included 348 individuals for efficacy analysis and 370 for safety and tolerability. The primary efficacy endpoint was change in monthly migraine days from week 1 to week 12 for all three trials, with secondary endpoints of reduction in acute medication use days (MUD) as well as quality-of-life based on answers to a migraine-specific questionnaire (MSQ v 2.1) for the same intervals.
Tassorelli and colleagues reported that atogepant 60mg demonstrated a significantly greater reduction in mean monthly migraine days (mean difference [95% CI]: 1.65 [2.49, 0.81]) across weeks 1 to 12, as well as in weeks 9 to 12 (-1.50 [-2.55 to -0.43] compared with rimegepant 75mg.)
Additionally, atogepant 60 mg showed greater reduction in acute MUDs compared with rimegepant 75 mg across weeks 1 to 12 (95% CI, -2.08 [-3.00 to -1.16]) as well as weeks 9 to 12 (-1.79 [-2.78 to -0.78]).
Regarding quality-of-life measures, atogepant 60 mg demonstrated a higher MSQ v2.1 RFR score (95% CI, 7.36 [1.8 to 12.82]) compared with rimegepant 75 mg at week 12.
The researchers noted that both drugs demonstrated similar safety and tolerability profiles.
“Future research comparing preventive migraine treatments would benefit from including analyses that identify participant characteristics that are associated with symptomatic improvement to one treatment option over another,” Tassorelli and colleagues wrote.