Claims Database Review Shows People With Migraine Decreased Opioid Use After Treatment With Rimegepant

A study using a large claims database, representing ~80% of prescription drug use in the US, shows a correlation between rimegepant (Nurtec; Biohaven, New Haven CT) use and discontinuation or reduced use of opioids among 14,019 people diagnosed with migraine. Rimegepant use was defined as refilling a prescription for rimegepant at least once in a 9-month period. Opioid use in this population was evaluated for the 9 months before and after individuals' first rimegepant prescriptions were filled. 

Opioid use decreased significantly after rimegepant was prescribed, by a monthly milligram morphine equivalent of 2.8% (P<.0001) and 16.1% fewer opioid refills (P<.0001). This reflects 40.5% of individuals with migraine treated with rimegepant discontinuing opioids in the 9 months after starting rimegepant treatment. Subanalysis showed discontinuation of opioids after starting rimegepant was similar between people who had used vs never used triptans (39.7% vs 41.3%, respectively). 

Rimegepant is a migraine-specific drug approved for acute treatment of migraine with or without aura as well as preventive treatment of episodic migraine. Rimegepant is an inhibitor of calcitonin gene-related peptide receptors, known to be involved in the pathophysiology of migraine. In contrast to opioids, which are not migraine-specific or recommended by the American Headache Society guidelines for migraine treatment, rimegepant does not cause tolerance, dependence, nor medication-overuse headache.  

Lead author and presenter, Noah Rosen, MD, Northwell Physician Partners, Neuroscience Institute of Great Neck, NY commented, "These real-world data show that when people are given a more specific migraine treatment, their use of opioids (as a population) decreases. We know many people with migraine are looking for treatment options that are best for them as individuals. Rimegepant provides clinicians and their patients with a more specific migraine treatment option that may result in overall safer treatment for patients with migraine by reducing opioid use." 

These data were presented at the American Association of Neurology 2022 Annual Meeting in Seattle, Washington, April 2-7.