Real-world Chinese data: Rimegepant effective, well tolerated in acute Tx of migraine

Rimegepant as acute therapy is effective and well tolerated in real-world Chinese patients with migraine, including those with very-high-frequency migraine (VHFM) days, prior nonresponders (PNRs) to any acute or preventive migraine treatment, and those on concomitant eptinezumab as preventive treatment, a study in China has shown.

The single-arm prospective study, which provides the first real-world evidence on rimegepant’s effectiveness and tolerability in acute treatment of migraine in Chinese patients, included 99 participants (female, 72.7 percent; mean age, 41.4 years; mean age at migraine onset, 19.8 years; PNR subgroup, n=30; concomitant rimegepant and eptinezumab [RE] subgroup, n=23) treated at the Neurology Clinic of Ruijin-Hainan Hospital affiliated with Shanghai Jiaotong University School of Medicine. The participants had a median of 10 monthly migraine days (MMDs) in the month before baseline visit. A majority (77.8 percent) had ≥3 accompanying symptoms during migraine attacks, and 35.4 percent were prescribed preventive treatment. [J Headache Pain 2024;25:160]

Study participants took rimegepant 75 mg as needed to treat migraine attacks. They were asked to record pain intensity, functional ability and accompanying symptoms for a single migraine attack predose and at 0.5, 1, 2, 24 and 48 hour(s) postdose via a digital platform. Adverse events (AEs) during rimegepant treatment were also recorded.

Results showed significant decreasing trends in the percentages of participants who experienced moderate to severe pain after taking rimegepant (p<0.05):

• Full population: From 51.5 percent predose to 10.1 percent at 48 hours postdose;
• PNR subgroup: From 46.7 percent predose to 7.4 percent at 48 hours postdose;
• RE subgroup: From 56.5 percent predose to 8.7 percent at 48 hours postdose.

“In participants with VHFM days [≥15 MMDs; n=41], rimegepant also showed a significant trend [p<0.05] in decreasing the percentages of those who experienced moderate to severe pain [predose, 48.8 percent; 48 hours postdose, 16.2 percent],” the investigators reported.

“The effects were all very prominent as early as 0.5 hours postdose and were sustained for up to 48 hours, confirming both early onset and durable effects of rimegepant in acute treatment of migraine,” they pointed out.

Compared with predose levels, the percentages of participants who reported better/good outcomes in terms of pain intensity, functional ability and accompanying symptoms increased significantly at 0.5, 1, 2, 24 and 48 hour(s) after taking rimegepant. These increases were observed in the full population as well as the PNR and RE subgroups. At 48 hours postdose, the vast majority of participants reported better/good outcomes in all three domains (full population, 91.0–98.9 percent; PNR subgroup, 92.6–96.3 percent; RE subgroup, 91.3–95.7 percent).

AEs were reported in 6.1 percent of participants in the full population, 13.3 percent of those in the PNR subgroup, and 4.3 percent of those in the RE subgroup. All reported AEs were mild.

“This real-world study demonstrates that rimegepant is effective and well tolerated for acute treatment of migraine in Chinese patients, even in those with VHFM days, a history of nonresponse, and those on concomitant eptinezumab. Overall, these results suggest that rimegepant is a promising treatment option for Chinese migraine patients,” the investigators concluded.