Real-world outcomes associated with initial oral CGRP receptor antagonist integration strategies in children and adolescents with migraine: a multicenter cohort study
Abstract
Abstract Background Evidence on how oral calcitonin gene-related peptide (CGRP) receptor antagonists can be integrated into preventive treatment strategies for children and adolescents with migraine remains limited. We evaluated real-world outcomes associated with different initial strategies for incorporating rimegepant into ongoing preventive management. Methods We conducted a retrospective multicenter cohort study using data from the China Headache and Vertigo Registry System. Patients aged ≤ 18 years were classified by initial treatment strategy: conventional preventive therapy without rimegepant integration, conventional preventive therapy plus regular rimegepant integration, or conventional preventive therapy plus acute-on-demand rimegepant integration. The primary outcome was a ≥ 50% reduction in monthly headache days (MHDs) at 4 months; a ≥ 75% reduction was secondary. Covariate-balancing propensity score–based overlap weighting using six prespecified covariates was combined with doubly robust outcome regression. Treatment trajectories and documented adverse events were summarized descriptively. Results Among 109 patients, 23 received conventional preventive therapy alone, 64 plus regular rimegepant integration, and 22 plus acute-on-demand integration. Adjusted probabilities of achieving ≥ 50% MHD reduction were 51.2%, 67.5%, and 78.6%, respectively. Compared with conventional therapy alone, adjusted risk differences were 16.3 percentage points (95% CI, − 8.8 to…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 109 participants or records.
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