Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine

Richard B. Lipton, Robert Croop, Elyse G. Stock, David A. Stock, Beth A. Morris, Marianne Frost, Gene M. Dubowchik, Charles M. Conway, Vladimir Coric, Peter J. Goadsby

Research output: Contribution to journalArticle

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Abstract

BACKGROUND Calcitonin gene-related peptide receptor has been implicated in the pathogenesis of migraine. Rimegepant is an orally administered, small-molecule, calcitonin gene-related peptide receptor antagonist that may be effective in acute migraine treatment. METHODS In a multicenter, double-blind, phase 3 trial, we randomly assigned adults with at least a 1-year history of migraine and two to eight migraine attacks of moderate or severe intensity per month to receive rimegepant orally at a dose of 75 mg or matching placebo for the treatment of a single migraine attack. The primary end points were freedom from pain and freedom from the most bothersome symptom (other than pain) identified by the patient, both of which were assessed 2 hours after the dose of rimegepant or placebo was administered. RESULTS A total of 1186 patients were randomly assigned to receive rimegepant (594 patients) or placebo (592 patients); of these, 537 patients in the rimegepant group and 535 patients in the placebo group could be evaluated for efficacy. The overall mean age of the patients evaluated for efficacy was 40.6 years, and 88.7% were women. In a modified intention-to-treat analysis, the percentage of patients who were pain-free 2 hours after receiving the dose was 19.6% in the rimegepant group and 12.0% in the placebo group (absolute difference, 7.6 percentage points; 95% confidence interval [CI], 3.3 to 11.9; P<0.001). The percentage of patients who were free from their most bothersome symptom 2 hours after the dose was 37.6% in the rimegepant group and 25.2% in the placebo group (absolute difference, 12.4 percentage points; 95% CI, 6.9 to 17.9; P<0.001). The most common adverse events were nausea and urinary tract infection. CONCLUSIONS Treatment of a migraine attack with the oral calcitonin gene-related peptide receptor antagonist rimegepant resulted in a higher percentage of patients who were free of pain and free from their most bothersome symptom than placebo.

Original languageEnglish (US)
Pages (from-to)142-149
Number of pages8
JournalNew England Journal of Medicine
Volume381
Issue number2
DOIs
StatePublished - Jul 11 2019

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Calcitonin Gene-Related Peptide Receptors
Migraine Disorders
Placebos
Confidence Intervals
Pain
Intention to Treat Analysis
Urinary Tract Infections
Nausea
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lipton, R. B., Croop, R., Stock, E. G., Stock, D. A., Morris, B. A., Frost, M., ... Goadsby, P. J. (2019). Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine. New England Journal of Medicine, 381(2), 142-149. https://doi.org/10.1056/NEJMoa1811090

Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine. / Lipton, Richard B.; Croop, Robert; Stock, Elyse G.; Stock, David A.; Morris, Beth A.; Frost, Marianne; Dubowchik, Gene M.; Conway, Charles M.; Coric, Vladimir; Goadsby, Peter J.

In: New England Journal of Medicine, Vol. 381, No. 2, 11.07.2019, p. 142-149.

Research output: Contribution to journalArticle

Lipton, RB, Croop, R, Stock, EG, Stock, DA, Morris, BA, Frost, M, Dubowchik, GM, Conway, CM, Coric, V & Goadsby, PJ 2019, 'Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine', New England Journal of Medicine, vol. 381, no. 2, pp. 142-149. https://doi.org/10.1056/NEJMoa1811090
Lipton, Richard B. ; Croop, Robert ; Stock, Elyse G. ; Stock, David A. ; Morris, Beth A. ; Frost, Marianne ; Dubowchik, Gene M. ; Conway, Charles M. ; Coric, Vladimir ; Goadsby, Peter J. / Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine. In: New England Journal of Medicine. 2019 ; Vol. 381, No. 2. pp. 142-149.
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abstract = "BACKGROUND Calcitonin gene-related peptide receptor has been implicated in the pathogenesis of migraine. Rimegepant is an orally administered, small-molecule, calcitonin gene-related peptide receptor antagonist that may be effective in acute migraine treatment. METHODS In a multicenter, double-blind, phase 3 trial, we randomly assigned adults with at least a 1-year history of migraine and two to eight migraine attacks of moderate or severe intensity per month to receive rimegepant orally at a dose of 75 mg or matching placebo for the treatment of a single migraine attack. The primary end points were freedom from pain and freedom from the most bothersome symptom (other than pain) identified by the patient, both of which were assessed 2 hours after the dose of rimegepant or placebo was administered. RESULTS A total of 1186 patients were randomly assigned to receive rimegepant (594 patients) or placebo (592 patients); of these, 537 patients in the rimegepant group and 535 patients in the placebo group could be evaluated for efficacy. The overall mean age of the patients evaluated for efficacy was 40.6 years, and 88.7{\%} were women. In a modified intention-to-treat analysis, the percentage of patients who were pain-free 2 hours after receiving the dose was 19.6{\%} in the rimegepant group and 12.0{\%} in the placebo group (absolute difference, 7.6 percentage points; 95{\%} confidence interval [CI], 3.3 to 11.9; P<0.001). The percentage of patients who were free from their most bothersome symptom 2 hours after the dose was 37.6{\%} in the rimegepant group and 25.2{\%} in the placebo group (absolute difference, 12.4 percentage points; 95{\%} CI, 6.9 to 17.9; P<0.001). The most common adverse events were nausea and urinary tract infection. CONCLUSIONS Treatment of a migraine attack with the oral calcitonin gene-related peptide receptor antagonist rimegepant resulted in a higher percentage of patients who were free of pain and free from their most bothersome symptom than placebo.",
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AU - Stock, Elyse G.

AU - Stock, David A.

AU - Morris, Beth A.

AU - Frost, Marianne

AU - Dubowchik, Gene M.

AU - Conway, Charles M.

AU - Coric, Vladimir

AU - Goadsby, Peter J.

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N2 - BACKGROUND Calcitonin gene-related peptide receptor has been implicated in the pathogenesis of migraine. Rimegepant is an orally administered, small-molecule, calcitonin gene-related peptide receptor antagonist that may be effective in acute migraine treatment. METHODS In a multicenter, double-blind, phase 3 trial, we randomly assigned adults with at least a 1-year history of migraine and two to eight migraine attacks of moderate or severe intensity per month to receive rimegepant orally at a dose of 75 mg or matching placebo for the treatment of a single migraine attack. The primary end points were freedom from pain and freedom from the most bothersome symptom (other than pain) identified by the patient, both of which were assessed 2 hours after the dose of rimegepant or placebo was administered. RESULTS A total of 1186 patients were randomly assigned to receive rimegepant (594 patients) or placebo (592 patients); of these, 537 patients in the rimegepant group and 535 patients in the placebo group could be evaluated for efficacy. The overall mean age of the patients evaluated for efficacy was 40.6 years, and 88.7% were women. In a modified intention-to-treat analysis, the percentage of patients who were pain-free 2 hours after receiving the dose was 19.6% in the rimegepant group and 12.0% in the placebo group (absolute difference, 7.6 percentage points; 95% confidence interval [CI], 3.3 to 11.9; P<0.001). The percentage of patients who were free from their most bothersome symptom 2 hours after the dose was 37.6% in the rimegepant group and 25.2% in the placebo group (absolute difference, 12.4 percentage points; 95% CI, 6.9 to 17.9; P<0.001). The most common adverse events were nausea and urinary tract infection. CONCLUSIONS Treatment of a migraine attack with the oral calcitonin gene-related peptide receptor antagonist rimegepant resulted in a higher percentage of patients who were free of pain and free from their most bothersome symptom than placebo.

AB - BACKGROUND Calcitonin gene-related peptide receptor has been implicated in the pathogenesis of migraine. Rimegepant is an orally administered, small-molecule, calcitonin gene-related peptide receptor antagonist that may be effective in acute migraine treatment. METHODS In a multicenter, double-blind, phase 3 trial, we randomly assigned adults with at least a 1-year history of migraine and two to eight migraine attacks of moderate or severe intensity per month to receive rimegepant orally at a dose of 75 mg or matching placebo for the treatment of a single migraine attack. The primary end points were freedom from pain and freedom from the most bothersome symptom (other than pain) identified by the patient, both of which were assessed 2 hours after the dose of rimegepant or placebo was administered. RESULTS A total of 1186 patients were randomly assigned to receive rimegepant (594 patients) or placebo (592 patients); of these, 537 patients in the rimegepant group and 535 patients in the placebo group could be evaluated for efficacy. The overall mean age of the patients evaluated for efficacy was 40.6 years, and 88.7% were women. In a modified intention-to-treat analysis, the percentage of patients who were pain-free 2 hours after receiving the dose was 19.6% in the rimegepant group and 12.0% in the placebo group (absolute difference, 7.6 percentage points; 95% confidence interval [CI], 3.3 to 11.9; P<0.001). The percentage of patients who were free from their most bothersome symptom 2 hours after the dose was 37.6% in the rimegepant group and 25.2% in the placebo group (absolute difference, 12.4 percentage points; 95% CI, 6.9 to 17.9; P<0.001). The most common adverse events were nausea and urinary tract infection. CONCLUSIONS Treatment of a migraine attack with the oral calcitonin gene-related peptide receptor antagonist rimegepant resulted in a higher percentage of patients who were free of pain and free from their most bothersome symptom than placebo.

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