Potentially Synergistic Effect Identified in Treatment with OnabotulinumtoxinA + Qulipta as a Prophylactic Polytherapy for Chronic Migraine

A majority of people with chronic migraine treated with onabotulinumtoxinA experienced a potentially synergistic effect when Qulipta (atogepant; Abbvie, North Chicago, IL) was added to their prophylactic regimen. The results of a single-site real-world observational study were presented at the 66th Annual Scientific Meeting of the American Headache Society (AHS). The findings suggest that onabotulinumtoxinA + Qulipta may constitute a potentially effective polytherapy for chronic migraine.

The study was conducted in a single clinic in a population of 234 patients with chronic migraine treated with a prophylactic regimen of onabotulinumtoxinA who were “partial positive responders” and who elected to receive Qulipta 60 mg daily. For 3 months prior to the initiation of treatment with Qulipta, participants were assessed for mean monthly migraine days, mean monthly headache days, mean monthly days of functionally incapacitating headache, mean monthly days of symptomatic medication use, migraine burden index (MBI), and Migraine Disability Assessment Scale (MIDAS) scores. These endpoints were reevaluated at 12 weeks after initiation of polytherapy.

Of the initial 234 participants, 211 completed 12 weeks of treatment with onabotulinumtoxinA and Qulipta. Of these, 132 individuals (63%) achieved the primary endpoint of a “positive response” as defined by a ≥50% reduction in mean monthly migraine days during the 12-week treatment period relative to the pre-Qulipta assessment. Additionally:

• Mean monthly headache days declined by 6.6 days.
• Mean functionally incapacitating headache days declined by 2.7 days.
• Mean monthly days of symptomatic medication use declined by 5.4 days.
• MBI score declined by 14.6 points.

The reductions in migraine and headache frequency and impact suggest that the combination of onabotulinumtoxinA and Qulipta was potentially synergistic. The authors of this study are affiliated with Inova Health and the University of Virginia.