Gepants provide benefit as preventive treatment for headache in young people

Key takeaways:

• Use of gepants generally led to some benefit for symptom relief in headache for youths.
• Adverse events were few and mild to moderate in intensity.

SAN DIEGO — In a small cohort of young people, use of gepants to treat headache led to some therapeutic benefit and led to few adverse events, according to a poster from the American Headache Society Annual Scientific Meeting.

“There’s not a lot of evidence-based treatment options in a pediatric population,” Lauren Shin, MD, child neurologist and headache fellow at the University of California, San Francisco, told Healio. “This (study) is to show real world off-label use in more of an adolescent population.”

Shin and colleagues sought to assess safety and efficacy of gepants for migraine prevention in patients aged 18 years and younger, as migraine affects 10% of this patient population and this class of calcitonin gene-related peptides have previously been FDA approved for use by adults.

They conducted a retrospective cohort study including 71 enrollees (median age 16 years; 77% girls) from three locations; Children’s Hospital of Philadelphia, Cincinnati Children’s Hospital Medical Center and UCSF previously prescribed rimegepant (n = 45), atogepant (n = 16) or both (n = 10) for preventive headache treatment.

The researchers collected demographic information as well as headache characteristics, side effects and outcome following treatment.

The median frequency of headache days per month for those taking rimegepant, atogepant or both were 30, while the median number of previous preventive treatments was seven for atogepant and six for rimegepant.

Results showed that almost 50% of study participants felt some benefit with rimegepant compared with 30% for atogepant. Conversely, more than 40% of the atogepant group stated the drug had no effect compared to roughly 35% for rimegepant. Slightly more than 10% of patients using rimegepant expressed there was significant benefit to usage compared with almost 15% of those taking atogepant.

In addition, adverse events were few, generally mild to moderate and only led to five instances of trial discontinuation.

“Ongoing randomized controlled trials will further address safety as well as efficacy,” Shin and colleagues wrote.