Real-world outcomes of zavegepant use in a tertiary care setting using the Migraine Treatment Optimization...

The introduction of calcitonin gene-related peptide antagonists has transformed migraine care. Zavegepant, a third-generation intranasal gepant, offers a nonoral treatment option for acute migraine. Although clinical trials support its efficacy and safety, real-world data are limited. This study reports patient-reported outcomes of zavegepant at a tertiary care center using the Migraine Treatment Optimization Questionnaire-5 (MTOQ-5) and additional survey questions.

In this single-center, descriptive, cross-sectional survey study of a retrospectively identified real-world cohort, data were collected from patients prescribed 10 mg intranasal zavegepant at the Cleveland Clinic between July 1, 2023, and December 31, 2024. Surveys were administered from January 2025 to March 2025. Eligible patients completed the MTOQ-5 and additional questions assessing dosage frequency, pain freedom, freedom from the most bothersome symptom, adverse events, and willingness to reuse zavegepant. Demographics including race, ethnicity, sex, age, body mass index, monthly migraine days, headache-free days, and number of preventive and rescue therapies prescribed prior to zavegepant use were also recorded. Of 99 patients surveyed, 60 responded and met inclusion criteria and were included in the analysis.

Among 60 included patients who used at least two doses, 27 of 60 (45%) patients reported pain freedom within 2 h of most attacks half the time or more, 17 of 60 (28%) reported less than half the time, and 16 of 60 (27%) reported never achieving pain freedom within 2 h. After zavegepant administration, 38 of 60 (63%) patients reported pain freedom within 2 h, and 10 of 60 (17%) patients reported pain freedom within 30 min of use. One dose of zavegepant relieving headache for at least 24 h was reported half the time or more in 26 of 60 (43%) patients. Following zavegepant use, 36 of 60 patients (60%) reported being able to return to normal activities half the time or more, and 43 of 60 (72%) felt comfortable planning daily activities half the time or more with zavegepant. Zavegepant was well-tolerated half the time or more in 41 of 60 (68%) patients. Dysgeusia was the most common adverse event reported. Overall, 43 of 60 (72%) patients would use zavegepant again.

This study represents the first retrospective, real-world, patient-reported outcome study on the use of zavegepant using the validated MTOQ-5. These findings suggest that intranasal zavegepant may be a useful acute migraine treatment option in clinical practice, with patient-reported improvement in pain, most bothersome symptom, function, tolerability, and willingness to reuse. However, the descriptive single-arm design and exclusion of single dose or nonusers limit interpretation and preclude comparative conclusions. Further real-world follow up with larger sample sizes is warranted to validate these findings.