Abstract Details

Title Real-world Effectiveness of Preventive Rimegepant: Longitudinal Outcomes Across Extended Follow-up Intervals

Topic Headache

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-020

Objective To quantify longitudinal changes in headache outcomes in subjects initiating rimegepant for migraine prevention.

Background While trials support rimegepant’s efficacy, real-world data on sustained preventive outcomes remain limited. Evaluating treatment effects across multiple time intervals is essential to understanding rimegepant’s long-term effectiveness.

Design/Methods Using EMR data with structured outcome forms collected during each visit, we analyzed longitudinal outcomes from subjects initiating preventive rimegepant at the Jefferson Headache Center (11/2020-7/2025). Subjects with only acute rimegepant use were excluded. The assessed duration encompassed all rimegepant exposure with assessable outcomes. Four datasets were constructed with follow-up capped at 3, 6, 12, or 24 months. Linear mixed-effects models (no imputation) with random intercepts estimated slopes for monthly headache days (MHD), moderate/severe headache days (MSD), worst pain intensity (WPI), average pain intensity (API), acute medication use days (AMD), and Migraine Disability Assessment (MIDAS) score. Models adjusted for sex, age, BMI, and concurrent onabotulinumtoxinA exposure.

Results Across 451 eligible subjects (age 45.3±14.8, female 83.6%, BMI 27.6±6.4), rimegepant use persisted in 84.3%, 66.1%, 35.7%, and 9.8% by 3, 6, 12, and 24 months. MHD declined at 3 months (–0.77 days/month, p=0.009), with smaller slopes at 6 (–0.46, p<0.001), 12 (–0.26, p<0.001), and 24 months (–0.11, p=0.007). MSD improved at 6 (–0.40, p=0.02) and 12 months (–0.25, p=0.003) before plateauing. WPI improved at 3 months (–0.17, p=0.003) and remained reduced. API improved only at 3 months (–0.23, p<0.001). AMD showed no significant change. MIDAS scores improved from 6 months onward (–2.3, p=0.04; –1.2, p=0.02; –1.0, p=0.0003).

Conclusions Preventive rimegepant was associated with early reductions in MHD, WPI, and API, while MSD and MIDAS improvements emerged later. These findings provide real-world data of early symptomatic benefit and evolving functional gains with rimegepant. Observed improvements reflect while-on-treatment outcomes; high discontinuation limits inference on sustained benefit.

Authors/Disclosures
Phillip Phan PRESENTER	Mr. Phan has nothing to disclose.
Scott Keith, PhD	Prof. Keith has nothing to disclose.
Michael Li	Michael Li has received personal compensation for serving as an employee of Jefferson Health. Michael Li has received personal compensation for serving as an employee of Pascal Metrics.
Meghan Fajardo, PharmD (Pfizer)	Dr. Fajardo has nothing to disclose.
Jessica Cirillo (Pfizer)	Mrs. Cirillo has received personal compensation for serving as an employee of Pfizer. Mrs. Cirillo has stock in Pfizer.
Jamie Rosini, PharmD	Dr. Rosini has nothing to disclose.
Karina Nakajima, PhD	Mrs. Nakajima has received personal compensation for serving as an employee of Pfizer. An immediate family member of Mrs. Nakajima has received personal compensation for serving as an employee of Bayer. An immediate family member of Mrs. Nakajima has received personal compensation for serving as an employee of Instituto Butantan.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.

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