Rimegepant significantly cuts monthly headache and migraine days in treatment-resistant migraine patients

Migraine is a debilitating neurological disorder, and while CGRP-based therapies have revolutionized treatment, real-world data on oral CGRP receptor antagonists like rimegepant for prevention remain scarce. Existing options, including anti-CGRP monoclonal antibodies, often fail in highly treatment-resistant patients. This study addresses the gap by evaluating rimegepant's effectiveness and tolerability in routine clinical practice, specifically in a population with multiple prior preventive failures.

This prospective, multicenter real-world cohort study enrolled 150 adults initiating rimegepant for migraine prevention across nine Spanish Headache Units. Patients were consecutively enrolled and followed for up to 6 months, with 64 completing the full duration. The primary endpoint was the 3-month change in monthly headache days (MHD). Secondary endpoints included changes in monthly migraine days (MMD), response rates, and tolerability, assessed via patient-reported outcomes like Headache Impact Test-6 (HIT-6) and HADS.

At 3 months, rimegepant significantly reduced monthly headache days (MHD) from a median of 12 to 7.5 (p<0.05), and monthly migraine days (MMD) from 10 to 6 (p<0.05). Significant improvements were also observed in HIT-6 scores. The cohort was predominantly female (85.3%) with a median of 6 prior preventive failures, reflecting high treatment resistance. > Overall, 36% of patients achieved a ≥50% reduction in MHD, while 43% achieved a ≥50% reduction in MMD at 3 months. Among the 64 patients with 6-month data, further reductions were noted, with MHD decreasing to 6 days and MMD to 5 days. At 6 months, ≥50% response rates increased to 48% for MHD and 58% for MMD. Notably, 15% and 20% achieved ≥75% reduction in MHD and MMD respectively at 3 months. Clinical responders also demonstrated greater improvements in anxiety and depressive symptoms.