Rimegepant bests placebo for acute migraine: meta-analysis

  • Gao B & al.
  • Front Pharmacol
  • 1 Jan 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • In acute migraine, vs placebo, 75 mg rimegepant yielded significantly greater pain relief/freedom from the most bothersome migraine symptoms within 2 hours of treatment.
  • The pain relief persisted at 48 hours after treatment.
  • Adverse event rates were similar.

Why this matters

  • Recent studies of rimegepant yielded conflicting results about efficacy and tolerability.

Study design

  • A meta-analysis of 4 RCTs involving 3827 patients.
  • Outcomes: freedom from pain and most bothersome symptom; pain relief at 2 hours.
  • Funding: Suzhou Health Talents Training Project.

Key results

  • At 2 hours, rimegepant (75 mg) vs placebo had significantly higher:
    • Freedom from pain: 20.6% vs 12.5% (relative risk [RR], 1.70; P<.001>
    • Pain relief: 58.6% vs 44.6% (RR, 1.34; P<.001>
    • Freedom from most bothersome symptoms: 36.0% vs 25.1% (RR, 1.44; P<.001>
  • Rimegepant vs placebo significantly reduced:
    • Photophobia: 35.5% vs 23.9% (RR, 1.49; P<.001>
    • Phonophobia: 40.1% vs 29.1% (RR, 1.41; P<.001>
  • No significant increase in AEs with rimegepant vs placebo:
    • Nausea (P=.105).
    • Urinary tract infection (P=.144).
    • Dizziness (P=.781).
  • At 48 hours, rimegepant vs placebo sustained the pain relief: 39.6% vs 24.1% (P<.001>

Limitations

  • No serious AEs identified.
  • No comparison with other drugs.