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#Grand Rounds

The New Migraine Medication: Is Rimegepant Effective?

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BACKGROUND AND PURPOSE:

  • Triptans are commonly prescribed for migraines but is not always effective and is contraindicated in some patients (e.g., CVD)
  • Calcitonin gene–related peptide (CGRP) is part of the pathway related to migraine symptoms
  • Lipton et al. (NEJM, 2019) conducted a phase 3 trial to evaluate the efficacy and safety of rimegepant (oral dose of 75 mg), compared to placebo, in acute migraine treatment

METHODS:

  • Multicenter, double-blind, phase 3 trial
  • Participants
    • ≥1-year history of migraine
    • 2 to 8 attacks per month (moderate or severe intensity)
  • Groups
    • Rimegepant group: 75 mg when a single migraine attack occurred
    • Placebo group: Matching placebo
  • Primary outcomes (assessed 2 hours after dose)
    • Freedom from pain
    • Freedom from the most bothersome symptom (other than pain)

RESULTS:

  • 1,186 patients | 88.7% were women | Mean age: 40.6 years
    • Rimegepant group: 537 evaluated
    • Placebo group: 592 patients
  • Rimegepant use resulted in a significantly greater percentage of patients who were pain free at 2 hours post migraine attack
    • Rimegepant group: 19.6%
    • Placebo group: 12.0%
    • Absolute difference: 7.6 percentage points (95% CI, 3.3 to 11.9; P<0.001)
  • Rimegepant use resulted in a significantly greater percentage of patients who were free of the most bothersome symptom at 2 hours post migraine attack
    • Rimegepant group: 37.6%
    • Placebo group: 25.2%
    • Absolute difference, 12.4 percentage points (95% CI, 6.9 to 17.9; P<0.001)
  • Most common adverse side effects
    • Nausea: 1.8% in the rimegepant group | 1.1% in the placebo group
    • UTI: 1.5% in the rimegepant group | 1.1% in the placebo group

CONCLUSION:

  • Rimegepant was superior to placebo for the treatment of moderate or severe migraine attacks
  • The authors recommend “larger and longer trials” to determine long term outcomes and safety profile

Learn More – Primary Sources:

Rimegepant, an Oral Calcitonin Gene–Related Peptide Receptor Antagonist, for Migraine

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Related ObG Topics:

FDA Approves Erenumab –  First Among a New Class of Drugs to Prevent Migraines
Is It a Migraine? Risk Factors and Diagnostic Categories
Migraine Treatment and Prevention
Cochrane Review: What is the Evidence for the Prevention of Migraines Using Botulinum toxins?
What are the Consequences of Taking Triptan for Migraine During Pregnancy?
Does Acupuncture Decrease Incidence of Migraines?

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