Patients with migraine report superior outcomes with ubrogepant compared to triptans

Key takeaways:

• A survey of 211 adults with migraine examined their experience with triptans or gepants.
• Ubrogepant was superior to triptans in pain relief and complete relief at 2 hours.

SAN DIEGO — Those with migraine who switched from an oral triptan to ubrogepant reported superior outcomes compared with patients who chose another triptan,, according to data presented at the American Headache Society Annual Scientific Meeting.

“Most treatment guidelines in the United States recommend that patients cycle through at least two different triptans before being considered for newer acute prescription medications such as the gepants,” Richard B. Lipton, MD, professor of neurology at Albert Einstein College of Medicine, and colleagues wrote.

“Evidence on the real-world effectiveness of gepants compared to triptans is lacking.”

Lipton and fellow researchers aimed to evaluate patient-reported outcomes among patients with migraine who switched from a prior oral triptan to another oral triptan or to ubrogepant.

Their prospective, longitudinal study (UNIVERSE II) recruited 211 adult respondents, who had experienced at least 6 headache days in the last 90 days and had access to enough of their triptan or ubrogepant medication to treat at least three migraine attacks, via the Migraine Buddy diary application. A total of 100 individuals reported switching to a new triptan and 111 reported switching to ubrogepant.

Participants were followed for 4 weeks with data collection including demographic and migraine characteristics at baseline, treatment satisfaction (with pain and symptom relief), medication experience vs. prior triptan, preference vs. the prior triptan and likelihood of continuing treatment with either ubrogepant or the new triptan. Complete migraine relief was defined as a meaningful change in pain level.

Sumatriptan (triptan, 58%; ubrogepant, 43.2%) and rizatriptan (triptan, 22%; ubrogepant, 33.3%) were the most common triptans participants reported using prior to switching.

Suboptimal or inconsistent migraine relief (triptan, 75.8%; ubrogepant, 70.3%) was reported as the most frequent reason for switching to the new treatment. Sensitivity to light (triptan, 34%; ubrogepant, 35.1%) and pain with routine activities (triptan, 19%; ubrogepant, 14.4%; excluding head pain) were reported as the most bothersome migraine symptoms in both cohorts.

At week 4, a significantly higher proportion of participants who switched to ubrogepant were satisfied with their choice treating migraine-associated pain (69.4% vs 42%) and alleviating the most bothersome symptoms (69.4% vs 42%) compared with those who switched to a new triptan.

Data additionally showed a significantly higher proportion of patients treated with ubrogepant reported better complete migraine relief at 2 hours than with their prior triptan (75.7% vs 59%) and preference for their new treatment over their prior triptan (75.7% vs 63%) than participants who switched to another triptan.

“These results represent real-world use and outcomes and can vary from results obtained in controlled randomized clinical trials,” Lipton and colleagues wrote.