To compare 12-month medication persistence between patients receiving rimegepant and oral triptans as needed for the acute treatment of migraine in the US.

Current standard of care for acute migraine treatment involves oral triptans; however, triptans are not suitable for all patients due to poor tolerability, insufficient effectiveness and contraindications. Rimegepant 75mg is a novel migraine therapy that fills an unmet need in this setting. Real-world persistence of treatment is an important proxy for effective and tolerable disease management, as well as patient satisfaction.

A retrospective cohort analysis of the US MarketScan administrative claims database from 1-Mar-2019 to 30-Jun-2023 was performed. New users of rimegepant (quantity 8 dispensed) or triptans (30 days’ supply) were compared. Persistence was defined as the proportion of patients with a repeat prescription of the index treatment within 12 months of initial prescription, calculated in 1:1 propensity score-matched cohorts and expressed as odds ratios (ORs) with 95% confidence intervals (CI). 

Prior to matching, 13,599 (rimegepant) and 38,127 (triptan) patients were included. After matching, cohorts each included 9,909 patients. Significantly more rimegepant patients were identified as persistent compared to triptan patients (75.8% and 53.5% respectively; OR 2.72, 95%CI 2.56, 2.90, p<0.001). Results were consistent in subgroup analyses in chronic migraine and comparing rimegepant to specific oral triptans (rizatriptan and sumatriptan). Results were robust to sensitivity analyses which varied the duration of follow-up and required two repeat prescriptions within 12 months.

Patients from the rimegepant cohort were significantly more likely to be persistent than patients in the oral triptan cohort, likely reflecting better response, tolerability and/or treatment satisfaction associated with rimegepant compared to oral triptan treatment.