The Efficacy and Safety of Rimegepant Every Other Day as Preventive Treatment for Migraine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
BACKGROUND: Rimegepant is an oral CGRP receptor antagonist initially approved for the acute treatment of migraine, demonstrating rapid onset of action and a favorable tolerability profile. Recently, a limited number of randomized controlled trials have evaluated its prophylactic use. The aim of this systematic review and meta-analysis is to assess the effectiveness and safety of rimegepant as a preventive therapy for migraine. METHODOLOGY: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (ID: CRD420251142208). We systematically searched Embase, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Science Direct, and Clinical trials.gov from inception to March 2026. Keywords and MeSH terms were applied to identify randomized controlled trials assessing rimegepant for migraine prevention compared with placebo. Primary efficacy endpoints were the change from the observation period in the mean number of monthly migraine days over the entire study period ( Weeks 1–12 ), in the last month (Weeks 9–12 ), and in the first month (Weeks 1–4 ) Additional primary outcomes include the change from baseline in MSQ scores, the proportion of participants achieving ≥ 50% reduction in moderate to severe migraine attacks from the observation phase, and the reported safety outcomes. RESULTS: Screening of 792 articles yielded four randomized controlled trials comprising 2,365 participants. Rimegepant significantly reduced monthly…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,365 participants or records.
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