Neurology and therapy · 2026
Real-World Effectiveness and Tolerability of Rimegepant as Second- or Third-Line Acute Treatment for Migraine: A Prospective Observational Study.
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Tanei Takafumi, Yamashita Satoshi, Yamamoto Shun, Muraoka Shinsuke, Ishizaki Tomotaka, Suzuki Takahiro, Shinoda Satoshi, Wakabayashi Toshihiko, Saito Ryuta
Аннотация
INTRODUCTION: Rimegepant is an oral calcitonin gene-related peptide receptor antagonist approved for both acute and preventive treatment of migraine. However, limited information is available regarding its effectiveness and tolerability when used as a second- or third-line acute treatment in patients for whom triptans and/or lasmiditan are ineffective, poorly tolerated, contraindicated, or otherwise unsuitable. This study evaluated the effectiveness and tolerability of rimegepant in this real-world clinical setting.
METHODS: A prospective observational study was conducted in 89 patients (76 female; mean age 40.6 ± 12.2 years) prescribed rimegepant 75 mg after prior use of triptans and/or lasmiditan. Participants self-recorded headache intensity using a visual analog scale (VAS) before and 2 and 4 h after taking rimegepant. Pain freedom was defined as a VAS score of 0, and treatment efficacy as a ≥ 50% reduction in VAS score. The Patient Global Impression of Change (PGIC) was assessed at 2 h. Continuation was defined as a request for ongoing prescription after the initial dose.
RESULTS: The study population included 35 patients (39.3%) with chronic migraine and 65 (73.0%) with prior calcitonin gene-related peptide (CGRP) monoclonal antibody exposure. Median VAS scores decreased from 77.0 at baseline to 18.0 at 2 h and 0.0 at 4 h (p < 0.001). Pain-free rates were 24.7% (95% CI 16.2-35.0%) at 2 h and 52.8% (95% CI 41.9-63.5%) at 4 h. Efficacy rates (≥ 50% VAS reduction) were 68.5% and 87.6% at 2 and 4 h, respectively. The continuation rate was 82.0%. Meaningful improvement on the PGIC was reported by 65.2% of patients. Adverse events occurred in 13.5% of patients. No adverse events leading to treatment discontinuation were observed.
CONCLUSION: Rimegepant was associated with clinically meaningful pain relief and favorable patient-reported outcomes when used as a second- or third-line acute treatment in real-world clinical practice.
METHODS: A prospective observational study was conducted in 89 patients (76 female; mean age 40.6 ± 12.2 years) prescribed rimegepant 75 mg after prior use of triptans and/or lasmiditan. Participants self-recorded headache intensity using a visual analog scale (VAS) before and 2 and 4 h after taking rimegepant. Pain freedom was defined as a VAS score of 0, and treatment efficacy as a ≥ 50% reduction in VAS score. The Patient Global Impression of Change (PGIC) was assessed at 2 h. Continuation was defined as a request for ongoing prescription after the initial dose.
RESULTS: The study population included 35 patients (39.3%) with chronic migraine and 65 (73.0%) with prior calcitonin gene-related peptide (CGRP) monoclonal antibody exposure. Median VAS scores decreased from 77.0 at baseline to 18.0 at 2 h and 0.0 at 4 h (p < 0.001). Pain-free rates were 24.7% (95% CI 16.2-35.0%) at 2 h and 52.8% (95% CI 41.9-63.5%) at 4 h. Efficacy rates (≥ 50% VAS reduction) were 68.5% and 87.6% at 2 and 4 h, respectively. The continuation rate was 82.0%. Meaningful improvement on the PGIC was reported by 65.2% of patients. Adverse events occurred in 13.5% of patients. No adverse events leading to treatment discontinuation were observed.
CONCLUSION: Rimegepant was associated with clinically meaningful pain relief and favorable patient-reported outcomes when used as a second- or third-line acute treatment in real-world clinical practice.