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Effectiveness of Rimegepant for the Acute Treatment of Migraine Among Participants Using Different Types of
Richard B Lipton1, Peter J Goadsby2,3, Patricia Pozo-Rosich4,5
1Montefiore Headache Center and the Albert Einstein College of Medicine, Bronx, NY, USA. richard.lipton@einsteinmed.edu.
Introduction:
This analysis assessed the real-world effectiveness of rimegepant for the acute treatment of migraine in patients taking different types of preventive medication.
Methods:
The prospective, observational, CONFIDENCE study recruited participants in the United States with 3-14 headache days/30 days and a rimegepant prescription for the acute treatment of migraine via the Migraine Buddy® app. Over a 28-day period, participants reported daily on the occurrence, treatment, and outcomes of migraine attacks. The proportion of rimegepant-treated attacks that achieved meaningful pain relief, meaningful improvement in function, or treatment satisfaction were calculated by preventive medication type [none; oral preventive medication (OPM) only; onabotulinumtoxinA (onaBoNT-A) with/without OPM; or calcitonin gene-related peptide monoclonal antibody (CGRP mAb) with/without OPM]. Pain and functional outcomes were compared between attacks treated with rimegepant versus other acute medication combinations using adjusted generalized linear mixed models with logit link and random intercept for each participant.
Results:
Among 2169 rimegepant-treated attacks, meaningful pain relief was achieved at 2 h and 4 h in 61.3% and 81.8%, respectively; corresponding values for meaningful improvement in function were 57.6% and 78.5%. Odds for all outcomes were higher with rimegepant versus other acute medication treatment combinations. Satisfaction with rimegepant treatment of the attack was > 60% across domains related to speed and effectiveness. Rates and adjusted odds ratios [aORs (95% CI)] for meaningful pain relief within 2 h with rimegepant versus other acute medication treatment combinations were: all attacks 61.3% versus 49.6%, aOR = 1.93 (1.52, 2.45), P < 0.001; no preventive medication 70.0% versus 41.8%, aOR = 4.56 (2.09, 9.92), P < 0.001; OPM 64.7% versus 56.5%, aOR = 1.76 (1.06, 2.90), P < 0.05; onaBoNT-A 62.0% versus 49.5%, aOR = 1.89 (1.24, 2.87), P < 0.01; and CGRP mAb 54.4% versus 46.8%, aOR = 1.66 (1.09, 2.53), P < 0.05.
Conclusion:
High rates of meaningful pain relief, meaningful improvement in function, and treatment satisfaction were observed with rimegepant for the acute treatment of migraine when used alongside different types of preventive medication in the real world.
Trial Registration:
ClinicalTrials.gov, NCT06467370. Graphical abstract available for this article.
