Efficacy, Safety, and Tolerability of Atogepant in Migraine Patients from the UAE

INTRODUCTION: Atogepant is an oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for migraine prevention; however, real-world data from the Middle East and North Africa (MENA) region remain limited. This study evaluated the efficacy and safety of atogepant in patients with chronic and episodic migraine in the United Arab Emirates. METHODS: This retrospective study included adult patients (≥ 18 years) diagnosed with chronic or episodic migraine who received atogepant for at least 6 months. Clinical data were extracted from electronic medical records at the American Center for Psychiatry and Neurology, Abu Dhabi. Monthly migraine days (MMD) at baseline were compared with follow-up MMD documented at visits occurring at least every 2 months. Safety outcomes were assessed through descriptive analysis of reported adverse events (AEs) in the all-exposed population. Sensitivity analyses (non-responder imputation, baseline observation carried forward, multiple imputation under MAR, and tipping point analysis) were conducted to evaluate the robustness of efficacy results in the presence of missing data. RESULTS: Of 86 patients identified, 59 met the inclusion criteria and their data were analyzed. Among these, 39% had chronic migraine and 61% had episodic migraine. The majority were female patients (86.4%) and Emirati nationals (69%). The mean baseline MMD was 12 (SD 8.1), which decreased to 4 (SD 5.2) at the most recent follow-up. Overall, 71% achieved ≥ 50% reduction in MMD, 20% achieved < 50% reduction, and 9% experienced no change. Paired-sample t test demonstrated a significant reduction in MMD t(58) = 9.44, p < 0.001. Adverse events were reported in 10.5% (9/86) of patients, most commonly constipation and nausea. Most patients experiencing AEs (78%) continued treatment, while two discontinued. CONCLUSION: In this real-world cohort from the UAE, atogepant was associated with significant reductions in monthly migraine days in both patients with chronic and episodic migraine and demonstrated a favorable safety and tolerability profile.