Atogepant vs Rimegepant, Galcanezumab: Which Is More Effective for Migraine?

Compared with rimegepant 75 mg and galcanezumab 120 mg monthly, atogepant 60 mg once daily is associated with greater clinical benefit across several efficacy outcomes, according to study results presented at the 2025 American Headache Society (AHS) Annual Scientific Meeting, held from June 19-22, in Minneapolis, Minnesota, and virtually.

In a network meta-analysis, researchers incorporated data from 5 randomized controlled trials, including the CHALLENGE-MIG (ClinicalTrials.gov Identifier NCT05127486) study, to compare the efficacy and safety profiles of 3 preventive treatments for episodic migraine: oral atogepant and rimegepant, and injectable galcanezumab. A fixed-effects model was applied to evaluate outcomes at 12 weeks.

Compared with placebo ([Odds Ratio] OR, 3.80; 95% CI, 2.55–5.67), rimegepant (OR, 2.29; 95% CI, 1.43–3.66), and galcanezumab (OR, 1.68; 95% CI, 1.07–2.64), atogepant significantly improved the odds of achieving at least a 50% reduction in monthly migraine days. Reductions in acute medication use were also greater with atogepant vs both rimegepant and placebo, and numerically greater than galcanezumab.

Patients receiving atogepant reported meaningful improvements in health-related quality of life. Scores on the Migraine-Specific Quality of Life Questionnaire version 2.1, particularly the Role Function-Restrictive domain, were significantly improved vs rimegepant and placebo, with numerical improvements over galcanezumab.

Rates of treatment-emergent adverse events (TEAEs) and all-cause discontinuation were similar across treatments. While atogepant was associated with slightly higher discontinuation rates and fewer TEAEs numerically, these differences were not statistically significant.

“Atogepant 60 mg demonstrated comparable all-cause d/c and TEAEs relative to rimegepant and galcanezumab,” the researchers concluded.

Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.