Network meta-analysis (NMA) of atogepant (Ato) relative to rimegepant (Rime) and galcanezumab (Galc) after inclusion of the CHALLENGE-MIG trial for efficacy and safety outcomes in episodic migraine (EM) patients.

A fixed-effects model was chosen to compare the efficacy and safety of Ato versus Rime, Galc based on model fit statistics. Efficacy results at 12 weeks are presented as odds ratio (OR) or estimates of mean difference with corresponding 95% confidence intervals (CI). Safety results are presented as hazard ratio and 95% CI.

After including CHALLENGE-MIG, the NMA showed Ato significantly increased the odds of achieving 50% RR in MMD compared to Rime (OR 2.29 (95% CI 1.43-3.66)), Galc (1.68 (1.07-2.64)), and placebo (Pbo) (3.80 (2.55-5.67)). Ato showed numerically higher MMD reductions compared to Rime and Galc, and significantly higher reductions compared to Pbo. Ato showed significantly greater reductions in acute medication use days compared to Rime and Pbo, and numerically greater reductions compared to Galc. Ato demonstrated significant improvement in Migraine Specific Quality of Life questionnaire version 2.1 Role Function-Restrictive domain score compared to Rime and Pbo, and numerical improvement compared to Galc. Ato demonstrated numerically higher all-cause discontinuations (d/c) and numerically lower treatment emergent adverse events (TEAEs) compared to Rime, Galc, and Pbo; however, these differences were not significant.

Ato 60 mg demonstrated significant improvements in 3 of the 4 efficacy outcomes compared to Rime 75 mg and significantly increased odds of achieving ≥50% RR in MMD relative to Galc 120 mg. Other efficacy outcomes were not significantly different. Ato 60 mg demonstrated comparable all-cause d/c and TEAEs relative to Rime and Galc.