Atogepant for the prevention of episodic migraine in adults

Abstract

Objective: Atogepant is a newly approved medication for the prevention of migraine. This review aims to discuss the efficacy, safety, cost, and place in therapy of atogepant. Methods: The authors performed a systematic search for sources, including articles, abstracts, and poster presentations. Queried databases were the National Institute of Health, US National Library of Medicine Clinical Trials, PubMed, European PMC, and the Cochrane Library. Search terms included atogepant, QULIPTA™, AGN-241689, MK-803, and N02CD07. Full-text, English language, randomized-controlled trials from 1 February 2012 to 1 February 2022 were included in the review. Additional relevant prescribing information, abstracts, and articles identified through the search were considered for inclusion in this review. A total of 193 database entries were evaluated for inclusion in this narrative review. Three articles representing two randomized controlled trials were reviewed. Results and conclusions: Atogepant, a small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist, is a daily oral treatment for migraine prevention. In placebo-controlled clinical trials, atogepant decreased mean monthly migraine days (MMD) over 12 weeks in patients with episodic migraine. Major treatment-related adverse effects include nausea and constipation. Long-term placebo-controlled efficacy and safety studies, chronic migraine studies, and studies in patients that failed more than two classes of preventive therapies are still pending. Atogepant represents one of many novel therapies for the prevention of migraine. To date, no head-to-head comparisons of atogepant versus other agents indicated for migraine prevention have been published. Atogepant offers patients an alternative therapy to injectable or infusion monoclonal antibody treatments and offers an alternative to non-specific migraine medications that are associated with poor tolerability. Due to its high cost and narrower therapeutic indications, atogepant may be reserved for a small subset of migraineurs who prefer oral therapy.

Gel-forming antagonist provides a lasting effect on CGRP-induced vasodilation

“…For example, ubrogepant treatment led to pain freedom at 2 h in 21.8% of acute migraine patients compared to 14.3% in the placebo group. The absolute difference in the pain-free rate was 6.4–7.5% ( Lipton et al, 2019 ; Switzer et al, 2022 ). In the meta-analysis, small molecule antagonists were shown to provide 2 h pain freedom in ∼20% of patients and pain relief in ∼60% ( Zhang et al, 2021 ; Altamura et al, 2022 ).…”

“…In addition to providing relief for acute migraine, small molecule anti-CGRP therapies such as atogepant and rimegepant, which are referred to as gepant compounds, are approved for preventive treatment ( Altamura et al, 2022 ; Switzer et al, 2022 ). It is known that anti-CGRP gepants could occupy a binding site close to the interface of the N-terminal domains of CLR and RAMP1, and act by allosteric regulation ( Miller et al, 2010 ).…”

Atogepant: the chief oral drug developed specifically for prophylactic treatment of episodic migraine

“…Although CGRP was first postulated to contribute to the pathogenesis of migraine in the 1980s, medicines that target the CGRP pathway through the CGRP ligand or receptor have just recently been licensed [7] . The gepants-small-molecule receptors blockers (ubrogepant, rimegepant, and atogepant)-and large-molecule antibodies (erenumab, eptinezumab, fremanezumab, and galcanezumab)-are 2 categories of drugs that target the CGRP pathway.…”

“…For the cure of migraines, Atogepant, a CGRP receptor antagonist, was given the FDA's approval. It provides patients with an alternative treatment to injectable or intravenous monoclonal antibody therapies as well as a substitute for poorly tolerated, nonspecific migraine medicines [7] .…”

“…Although atogepant serves as an effective treatment for migraines, it is yet to show results for chronic or resistant migraine sufferers. Thus, monoclonal antibodies will probably be chosen in patients who suffer from chronic or resistant migraines [7] . Monoclonal antibodies, atogepant, and rimegepant all show comparable efficacy and a possible cost hurdle.…”