Atogepant vs Rimegepant for Migraine Prevention: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a comparative efficacy study published in Cephalalgia that evaluated the relative efficacy and safety/tolerability of atogepant and rimegepant as preventive migraine treatments.

The study

Researchers used an anchored matching-adjusted indirect comparison (MAIC) analysis based on phase 3 trial data for both drugs to compare the relative efficacy, impact on quality of life (QoL), safety, and tolerability of atogepant vs rimegepant for preventive treatment of EM. MAIC analysis is an established mechanism for comparing results from studies that have used different methodologies.

For the analysis, they pooled data from a pair of phase 3 atogepant trials (ADVANCE and PROGRESS) and one phase 2/3 rimegepant trial.

Among the study participants receiving once daily atogepant 60 mg, there were 252 participants included in efficacy analysis and 259 in the analysis for safety and tolerability. Among rimegepant participants, treated every other day, 348 were included for the efficacy analysis and 370 for safety and tolerability.

The primary efficacy assessment was change in MMD from week 1 to week 12 for all 3 trials.

The findings

Investigators reported that daily atogepant 60 mg demonstrated a significantly greater reduction in mean MMDs across weeks 1–12 (MD [95% CI]: −1.65 [−2.49 to −0.81]; P < .001) and weeks 9–12 (MD [95% CI]: −1.50 [−2.55 to −0.43]; P < .01) compared with rimegepant 75 mg once every other day.

Authors' comment

"Our MAIC analysis adds to the current literature by demonstrating improved efficacy with atogepant compared with rimegepant, which may help to guide clinical decision making."

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