gepant treatments: effectiveness and tolerability (gainer)

Conditions: Migraine; Migraine with Aura; Migraine Without Aura; Chronic Migraine

Summary: the purpose of this prospective and multicentric study is to evaluate the effectiveness and tolerability of rimegepant as acute migraine treatment in a cohort of episodic or chronic migraine patients.

rimegepant belongs to the gepants family, small molecules calcitonin gene-related peptide (cgrp) receptor antagonists. it is a new generation gepants, currently available as an orally disintegrating tablet at a single dose of 75 mg. it has a double indication both for acute treatment for migraine with and without aura and preventive treatment of episodic migraine. previous randomized, placebo-controlled phase 3 trials and open label extensions demonstrated its effectiveness in the acute setting for a single migraine attack of both the oral tablet and the orally disintegrating tablet. pooled analysis of previous randomized clinical trials also showed rimegepant effectiveness in patients with a history of insufficient response to triptans. previous studies also demonstrated a good tolerability profile. the most commonly reported adverse events were nausea, nasopharyngitis, upper respiratory tract infections and urinary tract infection. in this prospective multicentric study we aim to evaluate rimegepant effectiveness and tolerability as acute migraine treatment in a real-world setting. subjects who meet the inclusion criteria will be enrolled and will participate in the study. baseline demographic and clinical data will be collected at the baseline. patients will be asked to treat their next migraine attack with rimegepant 75 mg orally disintegrating tablet. data will be collected at baseline, during at least 4 migraine attacks treated with rimegepant and at 3 months follow-up. subjects will be asked to complete assessment of their migraine attack at baseline and at 30 - 60 - 90 and 120 minutes after administration of the acute treatment for at least four migraine attacks. a final timepoint at 24 hours post-dose will be assessed only for the first attack. data collection will focus on: i) demographic data, ii) migraine history, iii) pain level and evolution, iv) presence and evolution of migraine associated symptoms, most bothersome symptom and aura, v) migraine associated disability, vi) patients's global impression of change (pgic) and evaluation on the acute treatment (migraine-act), vii) tolerability and eventual treatment-emergent adverse events. the online database redcap will be used for data collection.

Eligibility criteria:
inclusion criteria: * diagnosis of migraine without aura, migraine with aura, or chronic migraine according to the 3rd edition of the international classification of headache disorder (ichd-iii). * at least 3 mmds * good compliance to study procedures * availability of headache diary at least of the preceding months before enrollment exclusion criteria: * subjects with contraindications for use of gepants; * concomitant diagnosis of medical diseases and/or comorbidities that, in the investigator's opinion might interfere with study assessments; * medical comorbidities that could interfere with study results; * pregnancy and breastfeeding.

Keywords: headache medication overuse headache pain gepant triptan