New drug to prevent migraine may work instantly: study

By Stephen Beech

A drug to prevent migraine may start working right away, according to a new study.

People taking atogepant were less likely to have a migraine on the first day of taking it compared to those given a placebo, say American researchers.

They also had fewer migraines per week during each of the first four weeks of the study and fewer migraines during the study overall than those taking a placebo, according to the findings published in the journal Neurology.

The research team explained that atogepant is a calcitonin gene-related peptide (CGRP) receptor antagonist taken by mouth.

Study author Professor Richard Lipton, of Albert Einstein College of Medicine in New York, said: “With many current drugs to prevent migraine, it takes time to find the right dosage for the individual and it can take weeks or even months for it to be most effective.

“Some people give up and stop taking the drugs before they reach this point.

"Plus, many people experience side effects with current treatments. Developing a drug that works both effectively and quickly is critical.”

For the study, researchers looked at the data from three trials on the safety and effectiveness of atogepant over 12 weeks to focus on how rapidly improvements appeared.

The Advance trial, which enrolled people with episodic migraine, had 222 people taking the drug and 214 taking placebo.

The Elevate trial, which enrolled people with episodic migraine who had previously not responded well to other oral preventive treatments, had 151 on the drug and 154 on the placebo.

The Progress trial, which enrolled people with chronic migraine, had 256 on the drug and 246 on the placebo.

People with episodic migraine experience up to 14 migraine days per month.

People with chronic migraine experience at least 15 days of headache per month, with at least eight days being characteristic of migraine.

On the first day of the study, 12% of those taking the drug in the first trial, the advanced trial had a migraine, compared to 25% of those taking a placebo.

In the second trial, the Elevate trial, the numbers were 15% and 26%. For the third trial, the Progress trial, the numbers were 51% and 61%.

When the research team adjusted for other factors that could affect the rate of migraine, they found that people taking the drug were 61% less likely to have a migraine in the first trial, 47% less likely in the second trial, and 37% less likely in the third trial.

For the first two trials, the people taking atogepant had an average of one fewer days with migraine per week, compared to an average of less than one-half day fewer per week for those taking the placebo.

For the third trial, average migraine days per week declined by about 1.5 days for those taking the drug compared to about one day for those taking the placebo.

The people taking atogepant also showed improvement on assessments of how much migraines impaired their activities and their overall quality of life compared to people taking the placebo.

Prof Lipton added: “Migraine is the second-leading cause of disability in the overall population and the leading cause of disability in young women, with people reporting negative effects on their relationships, parenting, career and finances.

“Having a treatment that can act quickly and effectively addresses a key need.”