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Atogepant Reduces Migraine Days in Patients With Pain Medication Overuse
The calcitonin gene-related peptide inhibitor atogepant reduced monthly migraine and headache days, as well as days using pain medication, in patients with chronic migraine with and without acute medication overuse, according to a phase 3 randomized controlled trial published online in Neurology.
“There is a high prevalence of pain medication overuse among people with migraine as they try to manage what are often debilitating symptoms,” said study corresponding author Peter J. Goadsby, MD, PhD, of King’s College London in England. “However, medication overuse can lead to more headaches called rebound headaches, so more effective preventive treatments are needed. Our findings are encouraging, suggesting atogepant may help reduce the need for pain medication among people with chronic migraine.”
The double-blind trial included 755 adults with chronic migraine, which was defined as 15 or more monthly headache days with at least 8 qualifying as migraine over a 4-week baseline period. Participants were randomized 1:1:1 to placebo, atogepant 30 mg twice daily (BID), or atogepant 60 mg once daily (QD) for 12 weeks. Patients self-reported information about migraines, headaches, and use of the medications over the 12-week treatment period in an electronic diary.
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At baseline, 66.2% of participants met the criteria for acute medication overuse by taking simple analgesics, such as aspirin, nonsteroidal anti-inflammatory drugs, or acetaminophen, for at least 15 days a month; triptans or ergots for at least 10 days a month; or a combination of simple analgesics and triptans or ergots for at least 10 days a month.
Among patients with medication overuse, atogepant 30 mg BID resulted in an average 3 fewer monthly migraine days and 3 fewer monthly headache days compared with placebo. Atogepant 60 mg QD led to 2 fewer monthly migraine days and 2 fewer monthly headache days compared with placebo. Both atogepant groups also had 3 fewer days of taking pain medications compared with the placebo groups, according to the study. Similar results were observed in participants without medication overuse.
In patients with medication overuse, 45% of patients in the atogepant BID group and 42% in the atogepant QD group had a 50% or greater decrease in average monthly migraine days, researchers reported, compared with 25% in the placebo group.
Additionally, the number of participants meeting criteria for medication overuse fell by 62% in the atogepant BID group and 52% in the atogepant QD group, the study found.
“Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications,” Dr Goadsby said. “This could lead to an improved quality of life for those living with migraine.”
AbbVie, the maker of atogepant, funded the study. Dr Goadsby disclosed the receipt of personal fees from AbbVie during the study.
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