Nearly Half of Migraine Patients Discontinue Barbiturate Use After Initiating  Rimegepant

In a real-world study among people with migraine who used the barbiturate butalbital (n=24,359), 49% did not refill their butalbital prescription refills in the 6 months after starting treatment with rimegepant (Nurtec ODT; Biohaven, New Haven, CT). Overall, the mean monthly butalbital prescription fills decreased by 32% and the mean milligrams dispensed was reduced by 26%.

"This study has given a real-world insight into the impact that offering a more specific treatment can have on driving medication use away from older, nonspecific remedies,” said Noah Rosen, MD, Northwell Physician Partners, Neuroscience Institute of Great Neck, NY. “Furthermore, by initiating Nurtec ODT, not only did patients lower butalbital use, but also reduced concurrent caffeine, acetaminophen, or aspirin use due to their presence in these combination analgesics."

The study population was derived from an integrated commercial medical and prescription claims database. The data used contain patient-level claims with plan, payer, facility, procedure, medication, and diagnosis between September 15, 2019 and April 30, 2022.  

For each individual, data was evaluated from 180 days before to 180 days after filling their first of at least 2 prescriptions for rimegepant. All individuals evaluated had at least 1 prescription for a butalbital-containing prescription, excluding combinations of butalbital/codeine, filled in the 180 days before their first rimegepant prescription was filled. 

Rimegepant is a small-molecule CGRP receptor antagonist approved for the acute treatment of migraine attacks with or without aura and the preventive treatment of episodic migraine. Common side effects with rimegepant are nausea (2.7%) and stomach pain/indigestion (2.4%); allergic reactions have occurred in less than 1% of people treated that caused trouble breathing, and rash. In comparison, butalbital carries the potential for dependence and misuse disorder with a side-effect profile that includes nausea, vomiting, and other gastrointestinal irritability as well as drowsiness, dizziness, and other central nervous system effects.