Rimegepant Effective in Treatment-Resistant Migraine

TOPLINERimegepant achieved substantial reductions in headache burden and was well tolerated in patients with migraine who did not respond to multiple prior preventive treatments, including anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs).METHODOLOGYResearchers conducted a prospective multicentre real-world study to evaluate the effectiveness and tolerability of rimegepant for migraine prevention in a highly treatment-resistant population, particularly in patients who did not respond to multiple prior preventive therapies including anti-CGRP mAbs.They included 150 patients with migraine (median age, 48 years; 85.3% women) who initiated oral rimegepant 75 mg every other day between 2024 and 2025. All of them completed at least 3 months of follow-up.Participants did not respond to a median of six prior preventive therapies; 54.7% did not respond to prior onabotulinumtoxinA and 39.3% did not respond to prior anti-CGRP mAbs.The primary outcome was a change in the number of monthly headache days (MHDs) from baseline to month 3; secondary outcomes included a change in the number of monthly migraine days (MMDs), response rates (a reduction of ≥ 30%, ≥ 50%, or ≥ 75% in the number of MHDs or MMDs from baseline), clinical predictors of response, and tolerability profile.TAKEAWAYRimegepant significantly reduced headache burden over 3 months, with a median number of MHDs falling from 12 to 7.5 (mean decrease, -3.51 days) and MMDs declining from 10 to 6 (mean decrease, -2.89 days; P < .001 for both).At 3 months, 36% of patients achieved at least a 50% reduction in MHDs and 43% achieved the same reduction in MMDs, with at least a 75% reduction observed in 15% and 20%, respectively; 11% of patients achieved a complete remission of MMDs.After multivariable adjustments, medication overuse, prior failure to anti-CGRP mAbs and onabotulinumtoxinA, and chronic migraine were independent predictors of poorer outcomes, whereas episodic migraine emerged as a consistent predictor of better outcomes (P < .05 for all).Rimegepant was well tolerated, with predominantly mild adverse events. Nausea (13%) and constipation (8%) were the most commonly reported adverse events, and only 7% of patients discontinued the treatment during the first 3 months.IN PRACTICE"[The study] findings support the use of rimegepant in routine clinical practice, including in patients with prior exposure to CGRP-targeted therapies, at the same time as highlighting the impact of cumulative disease burden and prior treatment exposure on treatment response," the authors wrote.SOURCEThis study was led by Ana Beatriz Gago-Veiga, Hospital Universitario de la Princesa, Madrid, Spain. It was published online on July 06, 2026, in Cephalalgia.LIMITATIONSSample sizes were small in subgroup analyses. Psychometric and sleep parameters were evaluated only in a small subset of patients.DISCLOSURESThis study received support from the Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional and co-funding from the European Union. Some authors declared receiving honoraria and speaker honoraria and/or serving as clinical advisors to various pharmaceutical companies.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.