Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial

Croop, Robert; Lipton, Richard B.; Kudrow, David; Stock, David A.; Kamen, Lisa; Conway, Charles M.; Stock, E.; Coric, Vladimir; Goadsby, PJ

doi:10.1016/s0140-6736(20)32544-7

Cited by 248 publications

(303 citation statements)

References 33 publications

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“…For example, neuromodulation and biobehavioral therapies can be used alone or together with pharmacotherapy and/or other modalities in the acute and preventive treatment of appropriately selected patients. Among pharmacotherapies, frovatriptan is an established acute treatment that can have a role in the short‐term prevention of menstrual‐related migraine, 20 and regular use of drugs in the gepant class, two of which have been approved for acute treatment, has been shown to reduce attack frequency 66,67,120,121 …”

Section: Dual‐use Therapiesmentioning

confidence: 99%

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice

2021

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Objective To incorporate recent research findings, expert consensus, and patient perspectives into updated guidance on the use of new acute and preventive treatments for migraine in adults. Background The American Headache Society previously published a Consensus Statement on the use of newly introduced treatments for adults with migraine. This update, which is based on the expanded evidence base and emerging expert consensus concerning postapproval usage, provides practical recommendations in the absence of a formal guideline. Methods This update involved four steps: (1) review of data about the efficacy, safety, and clinical use of migraine treatments introduced since the previous Statement was published; (2) incorporation of these data into a proposed update; (3) review and commentary by the Board of Directors of the American Headache Society and patients and advocates associated with the American Migraine Foundation; (4) consideration of these collective insights and integration into an updated Consensus Statement. Results Since the last Consensus Statement, no evidence has emerged to alter the established principles of either acute or preventive treatment. Newly introduced acute treatments include two small‐molecule calcitonin gene‐related peptide (CGRP) receptor antagonists (ubrogepant, rimegepant); a serotonin (5‐HT1F) agonist (lasmiditan); a nonsteroidal anti‐inflammatory drug (celecoxib oral solution); and a neuromodulatory device (remote electrical neuromodulation). New preventive treatments include an intravenous anti‐CGRP ligand monoclonal antibody (eptinezumab). Several modalities, including neuromodulation (electrical trigeminal nerve stimulation, noninvasive vagus nerve stimulation, single‐pulse transcranial magnetic stimulation) and biobehavioral therapy (cognitive behavioral therapy, biofeedback, relaxation therapies, mindfulness‐based therapies, acceptance and commitment therapy) may be appropriate for either acute and/or preventive treatment; a neuromodulation device may be appropriate for acute migraine treatment only (remote electrical neuromodulation). Conclusions The integration of new treatments into clinical practice should be informed by the potential for benefit relative to established therapies, as well as by the characteristics and preferences of individual patients.

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Section: Dual‐use Therapiesmentioning

confidence: 99%

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice

2021

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“…Interestingly, gepants, the oral CGRP receptor antagonists, can act both as acute and as preventative migraine treatments [ 125 ]. This is particularly true for rimegepant, which has been proven effective in both roles by randomized controlled trials [ 126 , 127 , 128 ]. Telcagepant, taken perimenstrually for seven days, effectively reduced perimenstrual headache days, although not the absolute number of headache days, over placebo in a randomized controlled trial [ 129 ].…”

Section: Discussionmentioning

confidence: 99%

Acute and Preventive Management of Migraine during Menstruation and Menopause

Ornello

Felice

Caponnetto

et al. 2021

JCM

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Migraine course is influenced by female reproductive milestones, including menstruation and perimenopause; menstrual migraine (MM) represents a distinct clinical entity. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen levels. The present review provides suggestions for the treatment of MM and perimenopausal migraine. MM is characterized by long, severe, and poorly treatable headaches, for which the use of long-acting triptans and/or combined treatment with triptans and common analgesics is advisable. Short-term prophylaxis with triptans and/or estrogen treatment is another viable option in women with regular menstrual cycles or treated with combined hormonal contraceptives; conventional prevention may also be considered depending on the attack-related disability and the presence of attacks unrelated to menstruation. In women with perimenopausal migraine, hormonal treatments should aim at avoiding estrogen fluctuations. Future research on migraine treatments will benefit from the ascertainment of the interplay between female sex hormones and the mechanisms of migraine pathogenesis, including the calcitonin gene-related peptide pathway.

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“…The gepants, given their role as acute CGRP receptor antagonists, also represent an intriguing method for CGRP blockade in the acute posttraumatic timepoint. Because we are currently using them as acute migraine medications, and now with data demonstrating efficacy in migraine prevention [52], investigation of the gepants for the treatment of acute post-traumatic headache and prevention of persistent PTH will be an exciting next step.…”

Section: Future Studies Neededmentioning

confidence: 99%

Models for Treating Post-traumatic Headache

Kamins

2021

Curr Pain Headache Rep

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Purpose of Review To discuss the treatment of post-traumatic headache (PTH) and how to choose pharmacotherapy based upon known pathophysiology. Recent Findings Preclinical models of traumatic brain injury are finally revealing some of the mechanisms of PTH, including the significant role that inflammatory neuropeptides like calcitonin gene-related peptide (CGRP) play in the initiation and persistence of symptoms. Summary To effectively treat post-traumatic headache (PTH), one needs to understand the pathophysiology behind the initiation and persistence of symptoms. Recent animal models are starting to elucidate these mechanisms, but effective treatment will also likely rely on the identification of patients who are most at risk for persistent PTH. Trials of early, targeted therapy for at-risk patients will be needed to validate these hypotheses. Additionally, high powered clinical trials are lacking in the field of persistent PTH for medications that are known to be effective in primary headache disorders. Effective treatment for persistent PTH also requires understanding how headache interacts with the complex nature of persistent post-concussion symptoms, as this disease often necessitates a multi-disciplinary approach. Regardless, with the knowledge gained by new PTH models cited in this paper, and an increasing availability of novel headache medications, more effective treatment models are on the horizon.

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Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial

Cited by 248 publications

References 33 publications

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice

Acute and Preventive Management of Migraine during Menstruation and Menopause

Models for Treating Post-traumatic Headache

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