Rimegepant Shows Efficacy for Preventive and Acute Migraine Treatment

As published in The Lancet, results of a phase 2/3 clinical trial (NCT03732638) showed rimegepant (Nurtec; Biohaven Pharmaceuticals, New Haven, CT) was superior to placebo for migraine prevention. 

Treatment with rimegepant (75 mg every other day) reduced migraine days per month (MMD) by 4.3 days (95% CI: –4.8, –3.9) compared with a reduction of -3.5 MMD (95% CI: –4.0,–3.0) with placebo (P=.001). Notably, the positive response to rimegepant was seen during the first 4 weeks of treatment, which suggests an early onset of preventive effects. Rimegepant was superior to placebo on multiple secondary endpoints, including that 49% had at least a 50% reduction from baseline in mean MMD vs to 41% of those treated with placebo. 

Rimegepant is a calcitonin gene-related peptide (CGRP) receptor antagonist available as an orally disintegrating tablet. This is the first CGRP antagonist shown to have efficacy for both acute and preventive treatment of migraine, a significant advance considering that previously available acute treatments have carried the risk increasing, rather than reducing, MMD by causing medication-overuse headache. 

“These data demonstrate the continued innovation in migraine treatment aimed at CGRP mechanisms,” said Peter J. Goadsby, MD, PhD, DSc, professor of neurology, King’s College, London, and the University of California, Los Angeles. “This is the first time an oral CGRP migraine treatment has shown dual efficacy in both the acute and preventive treatment of migraine. With this flexibility, these therapies are truly disruptive and change the treatment paradigm for people living with migraine.”

Individuals in the trial were randomly assigned to receive rimegepant (75 mg; n=348) or placebo (n=347) every other day and all who took at least 1 dose were included in the efficacy analysis.