Retrospective cohort study of anti-CGRP monoclonal antibody unresponsive migraine individuals treated with atogepant: The RESCUE study
Abstract
Background A subset of individuals with episodic migraine (EM) and chronic migraine (CM) does not respond to anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs), even after switching agents. Although atogepant is effective in EM and CM, its role in individuals unresponsive to anti-CGRP mAbs remains to be elucidated. We hypothesize that atogepant may be a viable preventive option in these cases. Methods We conducted a retrospective cohort study in EM and CM individuals who discontinued anti-CGRP mAbs due to lack or loss of efficacy and were subsequently treated with atogepant. The primary endpoint was the ≥50% response rate in monthly headache days (MHDs). Secondary outcomes included ≥30% and ≥75% response rates in MHDs, response rates in monthly moderate-to-severe headache days (MSHDs), and changes in MHDs, MSHDs, acute medication days (AMDs) and Headache Impact Test (HIT-6). Patient Global Impression (PGI) scores and adverse events (AEs) were recorded. Results Of 213 screened records, 44 participants met inclusion criteria; 39 (88.6%) were female and 39 (88.6%) had CM. Prior use of anti-CGRP mAbs included erenumab in 11.4% of participants, galcanezumab in 52.3% and fremanezumab in 86.3%. After three months, 18.2% achieved a ≥50% reduction in MHDs; ≥30% and ≥75% response rates were 25.0% and 6.8% respectively. For MSHDs, ≥30%, ≥50% and ≥75% response rates were 47.6%, 33.3% and 19.0%, respectively. Median MHDs decreased from 24.5 (interquartile range…
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: 44 participants or records.
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