Investigational Rimegepant Effective for Patients With Migraines Resistant to Triptans
July 10, 2019

Rimegepant eliminated pain and reduced bothersome symptoms for people with migraines, according to a study published in The New England Journal of Medicine.

The drug may offer advantages over currently available migraine medications, according to Richard B. Lipton, MD, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York.

“For the first time in nearly three decades, people with migraine not helped by existing medications may have a new option to find relief during attacks,” he said.

Although triptans are the most commonly used medications for migraine sufferers, they can produce intolerable side effects, and because they constrict vessels, they shouldn’t be taken by people with cardiovascular disease (CVD) or major CVD risk factors.

Gepants work by targeting the receptors for a small protein, called CGRP, long implicated in migraine. During migraine attacks, CGRP is released resulting in pain. Gepants relieve the pain and other symptoms of migraine by blocking the CGRP pathway.

The current trial assessed rimegepant in more than 1,000 men and women with migraine across 49 centres in the United States. Participants were randomised to rimegepant or placebo during a migraine attack, once moderate or severe pain developed.

Before taking the tablet and for 48 hours afterwards, patients answered questions in an electronic diary concerning their pain and their most bothersome symptoms. Participants chose their most bothersome symptom from a list, including intolerance to light, intolerance to loud sounds, or nausea.

Two hours after taking their tablets, 19.6% of patients in the rimegepant group were free from pain compared with 12.0% in the placebo group. Freedom from their most bothersome symptoms occurred in 37.6% of patients in the rimegepant group and 25.2% in the placebo group.

Side effects were minimal, with nausea and urinary tract infections the only adverse effects reported in more than 1% of patients in each group and no adverse CVD effects observed.

“These results confirm that rimegepant’s mechanism of action -- blocking the CGRP pathway -- effectively relieves pain and associated symptoms that occur during acute migraine attacks,” said Dr. Lipton. “As someone who has studied CGRP blockers for more than a decade, I’m gratified to see their benefits confirmed in a large-scale clinical trial.”

Reference: Not Available

SOURCE: Montefiore Health System