Article of the Month by David Burke

Monoclonal antibodies that target calcitonin gene–related peptide (CGRP) have been introduced to reduce onset of migraines. Atogepant is an orally available CGRP with an elimination half-life 11 hours.  This study assessed the efficacy of this medication for preventing migraines in patients with episodic migraine.

  This multicentered double-blind placebo controlled trial included patients with episodic migraine randomized to receive a placebo or atogepant dosed at 10 mg, 30 mg or 60 mg.  The patients were seen at baseline and then at weeks two, four, six, eight, and 12.   This final visit was at week 16, four weeks after the end of the treatment. The primary efficacy end point was the change from baseline in the mean number of migraine days per month across the 12-week treatment period.

A total of 2270 persons were screened.  The mean number of migraine days per months was reduced by 3.7 and a 10 mg, 3.9 with a 30 mg, 4.2 with 60 mg and 2.5 with a placebo (p<0.001 for all comparisons with placebo).  A reduction of 50% or more in the three month average of migraine days per month occurred in 55.6% of those in the 10 mg group, 58.7% in the 30 mg, 60.8% thousand 60 mg and 29% of those in the placebo group(p<0.001 for all, compared with placebo). 

Ailani, J et al., Atogepant with a Preventative Treatment of Migraine.  N Engl J Med 2021, Aug 19; 385:695-706.