Acute Migraine Pain Relief With Oral Rimegepant Yields Lasting Benefits

By Megan Brooks

September 21, 2019

NEW YORK (Reuters Health) - The acute treatment of migraine with rimegepant can provide lasting reduction in migraine-related disability and improved quality of life, according to new data presented earlier this month at the International Headache Conference (IHC) in Dublin, Ireland.

Rimegepant is an investigational oral calcitonin gene-related peptide (CGRP) receptor being developed by Biohaven Pharmaceuticals.

"These compelling findings, showing sustained improvements in both migraine-specific disability and quality of life, suggest an added long-term benefit of rimegepant that derives from the effective acute treatment of migraine," study presenter Dr. Gil L'Italien of Biohaven Pharmaceuticals said in a news release.

"Both disability and quality of life improvements exceeded the minimum clinically important difference by more than two-fold. These benefits have important implications for reducing health care costs, improving workplace productivity, and overall enhanced patient wellbeing," he added.

At the Dublin meeting, Dr. L'Italien presented data from a multicenter, long-term, open-label, safety study of rimegepant (75 mg up to once daily as needed) in more than 1,700 adults with a history of frequent moderate/severe migraine attacks.

Acute treatment with rimegepant was associated with about a 41% decrease in disability as measured by the Migraine Disability Assessment (MIDAS), transitioning patients from severe to moderate disability by week 12 and beyond. Improvements in MIDAS scores were statistically significant (P<0.0001) relative to baseline, across all time points.

Rimegepant also led to significant improvements in daily functioning and health-related quality of life as measured by the Migraine-Specific Quality of Life Scale (MSQoL), as well as reduced lost productivity time over the year-long treatment period.

Rimegepant led to significant improvement in "absenteeism from work or presenteeism in family life," study investigator and Biohaven CEO Dr. Vladimir Coric noted in a phone interview with Reuters Health. "For these patients, it meant that they got back 8 to 9 days of their life every month. That's a big deal for someone who is disabled from their migraines."

Rimegepant was well tolerated with only 2.8% of patients reported to have discontinued due to an adverse event. The most common AEs were nausea (1.6%) and urinary-tract infection (1.5%).

What's novel about rimegepant, said Dr. Coric, is that it has "placebo-like tolerability, works within minutes, and because of its long half-life it lasts for two days so it's both an acute treatment and preventive agent. That's a message that I think will resonate with patients."

According to Biohaven, rimegepant is the only oral CGRP receptor antagonist currently in development for both the acute and preventive treatment of migraine. The drug is currently pending approval in gthe U.S. for acute treatment of migraine, with a decision expected by the end of this year.

A phase 3 trial of rimegepant as a migraine preventive agent is underway, with topline data expected by the end of the year.


International Headache Conference 2019.