Atogepant vs Rimegepant: Which Is Superior as a Preventive Migraine Treatment?

Compared with taking 75 mg of rimegepant orally every other day, taking 60 mg of atogepant orally daily leads to a significant decrease in the number of migraine days per month, according to the findings of a matching-adjusted indirect comparison (MAIC) analysis published in Cephalalgia.

Migraine, a leading cause of disability worldwide, differs in its severity and can significantly affect quality of life. Treatments like oral calcitonin gene-related peptide (CGRP) receptor antagonists, including atogepant and rimegepant, have proven effective in reducing the number of migraine days. However, the lack of direct comparisons between these treatments calls for advanced analytical methods such as MAIC to provide clear clinical guidance.

To elucidate this relationship, researchers combined data from phase 3 trials (ADVANCE; ClinicalTrials.gov Identifier: NCT03777059 and PROGRESS; ClinicalTrials.gov Identifier: NCT03855137) of atogepant, matched to data from the phase 2/3 trial (BHV3000-305; ClinicalTrials.gov Identifier: NCT03732638) of rimegepant to compare the efficacy and safety of atogepant and rimegepant for the preventive treatment of migraine.

The researchers assessed endpoints such as change in migraine days, differences in acute medication use days, and changes in quality of life scores, and safety across a 12-week treatment period.

The analysis included participants taking atogepant 60 mg daily, rimegepant 75 mg every other day, and placebo, who met the BHV3000-305 criteria: experiencing 6 migraine days and 18 headache days monthly at baseline.

The atogepant group consisted of 252 participants, while the rimegepant group comprised 348 participants.

Compared with rimegepant 75 mg, atogepant 60 mg exhibited greater improvements in reducing monthly migraine days (mean difference [MD], 1.65; 95% CI, 2.49, 0.81; P <.001), while also demonstrating better outcomes in reducing acute medication use days and improving migraine-specific quality of life scores throughout the treatment period.

Compared with participants who took rimegepant 75 mg every other day, those who received atogepant 60 mg daily had comparable rates of adverse events (odds ratio [OR], 0.91; 95% CI, 0.56, 1.45; P =.6773) and a slightly elevated chance of discontinuing treatment (OR, 1.43; 95% CI, 0.69, 3.06; P =.3284). However, these differences did not reach statistical significance.

Overall, atogepant 60 mg daily and rimegepant 75 mg every other day were well-tolerated and demonstrated comparable safety profiles.

“In addition to conducting head-to-head trials, future research comparing preventive migraine treatments would benefit from including analyses that identify participant characteristics that are associated with symptomatic improvement to one treatment option over another,” the researchers noted.

Study limitations included exclusion criteria impacting randomization, unmatchable efficacy data for rimegepant, and potential confounding factors in the combined chronic and episodic migraine populations.

Disclosures: This research was supported by AbbVie, Inc. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.