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Background and Importance Migraine is a prevalent headache disorder with significant impact on quality of life. New oral CGRP receptor antagonists, including rimegepant and atogepant, have emerged as preventive treatments for patients with diagnosis of episodic and chronic migraine, respectively, but real-world data on their efficacy and safety remain limited.Aim and Objectives To evaluate the impact of rimegepant and atogepant on migraine frequency, quality of life, safety, tolerability, and treatment adherence at 3 and 6 months.Material and Methods This retrospective, single-cohort study included adult patients (≥18 years) with episodic or chronic migraine who initiated rimegepant or atogepant in 2025. Inclusion required minimum ≥3 months of follow-up. Data on previous and concomitant treatments, monthly migraine days (MMD), headache intensity test (HIT-6), adverse events, adherence, and discontinuation were collected at 3 and 6 months. A descriptive statistical analysis was conducted.Results Forty patients (77.5% women, mean age 53 years) were included. Eighteen received rimegepant and 22 atogepant, though one never initiated treatment. At baseline, atogepant patients had higher MMD (rimegepant 11.3±2.2 vs atogepant 21.7±6.4, p<0.05) and HIT-6 scores (rimegepant 67.1±5.9 vs atogepant 70.7±5.9, p=0.0694). All patients had prior preventive treatments, 8 patients w/rimegepant and 10 w/atogepant followed concomitant prophylactics.At 3 months, mean MMD decreased to 8.1±3.7 w/rimegepant (n=14) and 15.1±10.3 w/atogepant (n=16). HIT-6 scores improved to 63.6±9.8 (n=14) and 64.1±10.2 (n=10), respectively. Three patients in each group had ≥50% reduction in MMD and/or <4 MMD after 3-month treatment. One patient in each group were considered non-adherent. At 6 months, only four patients w/rimegepant reached follow-up; one discontinued and data was missing for three patients.Treatment duration was longer w/rimegepant (3.5±1.3 months vs 2.0±1.0, p=0.025). Nine rimegepant patients discontinued due to lack of efficacy. Tolerability was generally good. For atogepant, six patients stopped due to adverse events, most commonly fatigue, constipation and other gastrointestinal symptoms. No cardiovascular events were reported.Conclusion and Relevance Oral CGRP antagonists effectively reduced migraine frequency and improved quality of life in real-world settings. Atogepant showed better outcomes, while rimegepant had better tolerability. Discontinuations were mainly due to lack of efficacy (rimegepant) and adverse events (atogepant). Overall adherence remained high with no major safety concerns.References and/or Acknowledgements 1. https://doi.org/10.1007/s11916-022-01077-z2. https://doi.org/10.3389/fphar.2024.1431562Conflict of Interest No conflict of interest