Abstract Details

Title A Preliminary Systematic Review and Meta-analysis of Randomized Control Trials of Rimegepant and Zavegepant for Acute Pain Relief from Migraine

Topic Headache

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-004

Objective

Our aim was to compare the efficacy of Rimegepant and Zavegepant in relieving pain from migraine in acute settings.

Background There is limited research summarizing the efficacy of newer gepants in migraine therapy. Rimegepant and Zavegepant have different administration routes, oral vs intranasal, respectively.

Design/Methods We reviewed the randomized clinical trials (RCTs) for Rimegepant and Zavegapant registered between 2017 and 2023 in the database of the NIH’s National Library of Medicine (clinicaltrials.gov). To compare the efficacy of the two medications, we conducted a random-effects meta-analysis of the RCTs for the percentage of pain relief from headache at two hours and 24 hours. Pain relief from headache was measured on a 4-point scale (none, mild, moderate, severe) and recorded as a dichotomized variable. All analyses were performed in R.

Results We included three RCTs for Rimegepant and two RCTS for Zavegapant that contained our outcome of interest. All five RCTs were conducted in the United States, were double-blinded with placebo control, and enrolled a majority of females (all RCTs >84%). Overall, the percentages of pain relief from headache at two hours and at 24 hours were 58.5% [95% Confidence Interval (CI): 56.6%-60.3%] and 42.6% [95% CI: 39.9%-45.4%], respectively, for the treatment groups among the five RCTs. For Rimegepant, the percentage of pain relief from headache was 58.0% [95% CI: 56.0%-60.2%] at two hours and 43.2% [95% CI: 39.0%-47.5%] at 24 hours. For Zavegapant, the percentages of pain relief from headache was 59.5% [95% CI: 56.4%-62.5%] at two hours and 41.5% [95% CI: 38.5%-45.5%] at 24 hours.

Conclusions Our results suggest that Rimegepant and Zavegepant might be equally efficacious in providing acute pain relief from migraine. However, further review of RCTs and observational studies is warranted to elucidate the efficacy of gepants for acute pain relief from migraine

Authors/Disclosures
Sakina Matcheswalla, MBBS PRESENTER	Dr. Matcheswalla has nothing to disclose.
Kuldeep Yadav	No disclosure on file
Rahul Jena, MBBS (RWJBH)	Mr. Jena has nothing to disclose.
Lakshmi Sai Deepak Reddy Velugoti, MD	No disclosure on file
Prince K. Pekyi-Boateng, MBBS	Dr. Pekyi-Boateng has nothing to disclose.
Aleksei Budnik	No disclosure on file
Zabeen K. Mahuwala, MD, FAAN (University of Kentucky, KY Clinic Neurology Department)	Dr. Mahuwala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Mahuwala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for academic CME. Dr. Mahuwala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen Scientific affairs. Dr. Mahuwala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for amgen. The institution of Dr. Mahuwala has received research support from UCB, . The institution of Dr. Mahuwala has received research support from Alexion . The institution of Dr. Mahuwala has received research support from argenx . The institution of Dr. Mahuwala has received research support from immunovant.

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