Post Hoc Analysis of Time to First and Sustained Improvement in Weekly Migraine Days Among Patients Receiving Preventive Treatment With Rimegepant 75 mg

For preventive migraine treatment, understanding an intervention’s onset, extent of action, and duration can help set realistic treatment expectations and may help prevent both premature discontinuation and reduce unnecessary prolonged exposure. Rimegepant is an oral calcitonin gene-related peptide receptor (CGRP) antagonist with demonstrated efficacy in the acute and preventive treatment of migraine. This post hoc analysis aimed to assess the onset of benefits of rimegepant 75 mg for the preventive treatment of migraine. Median (25th, 75th percentiles) time to first and sustained reductions in weekly migraine days (WMDs) were estimated. Improvements from baseline were evaluated in 10% increments. Time to first improvement was based on the first week that a reduction of a particular magnitude was achieved, and time to sustained improvement was defined as the week that a reduction at a particular level was achieved and that persisted, on average, until study end. Among 370 participants, the median (25th, 75th percentiles) time to first reduction in WMDs of ≥ 50% was 2 (1, 4) weeks. Thus, 50% of patients are expected to experience ≥ 1 week with a ≥ 50% reduction in WMDs within the first 2 weeks. The median (25th, 75th percentiles) time to a sustained reduction in WMDs of ≥ 50% was 3 (1, 14) weeks. Accordingly, 50% of patients are expected to experience a ≥ 50% reduction in WMDs by week 3 and to maintain this improvement, on average, up to week 64. Following rimegepant 75-mg treatment initiation, it is expected that 50% of patients will experience first ≥ 50% reduction in WMDs by week 2 and sustained reduction by week 3. Graphical abstract available for this article. ClinicalTrials.gov number: NCT03732638. https://www.clinicaltrials.gov/study/NCT03732638 . Migraine is a common condition that causes repeated headaches called migraine attacks. A migraine treatment that is taken regularly to help prevent future migraine attacks is called a preventive treatment. It is important to know when a preventive migraine treatment will begin to work and for how long its benefits will last. This may help people use the treatment long enough to benefit, but may also help stop people from using it for too long if no benefit is seen. Rimegepant is an approved preventive migraine treatment. Researchers in this study wanted to measure how long it took for rimegepant to work as a preventive treatment. To do this, they used data from another completed clinical study. Researchers looked at changes in the number of days when a person has migraine symptoms (called migraine days). They measured how long it took to see a first reduction in the average number of migraine days during a week (called weekly migraine days) and how long it took until this weekly reduction lasted to the end of the study. A total of 370 people who took rimegepant as a preventive treatment were studied, and it was found that, within the first 2 weeks of treatment, half the number of people who take rimegepant can expect to have at least 1 week where their number of weekly migraine days is at least halved. After 3 weeks of rimegepant preventive treatment, this benefit became consistent and lasted on average to the end of the study (up to 64 weeks).