Drug appears to alleviate migraine symptoms early after onset

Atogepant, an oral drug approved to prevent migraine, appears to also alleviate migraine symptoms early after onset has begun.

The findings were reported on December 23, 2024 in Neurology.

“With many current drugs to prevent migraine, it takes time to find the right dosage for the individual and it can take weeks or even months for it to be most effective,” said study author Richard B. Lipton, MD, professor of neurology at the Albert Einstein College of Medicine in the Bronx, New York, and a Fellow of the American Academy of Neurology. “Some people give up and stop taking the drugs before they reach this point. Plus, many people experience side effects with current treatments. Developing a drug that works both effectively and quickly is critical.”

The subjects in the newly reported analysis of data from three studies of atogepant were less likely to report a migraine on the first day of taking the drug compared to subjects taking a first-day placebo.

They also reported fewer migraines per week during each of the first four weeks of the study, and fewer overall migraines during the 12 weeks of the study.

Investigators in the ADVANCE trial enrolled subjects with episodic migraine; 222 took atogepant and 214 took a placebo.

Researchers in the ELEVATE trial enrolled subjects with episodic migraine who had previously not responded well to other oral preventive treatments; 151 took atogepant and 154 took a placebo.

Investigators in the PROGRESS trial enrolled subjects with chronic migraine; 256 took atogepant and 246 took a placebo.

For the ADVANCE trial, 12% of those treated with atogepant suffered a first-day migraine, compared to 25% of those taking placebo.

For the ELEVATE trial, 15% of the subjects treated with atogepant suffered a first-day migraine compared to 26% of those taking a placebo.

For the PROGRESS trial, 51% of the subjects treated with atogepant suffered a first-day migraine compared with 61% of those taking a placebo.

For the 12 weeks of the study and after adjusting for factors that might affect the rate of migraine, the researchers reported that subjects treated with atogepant in ADVANCE were 61% less likely to report migraine symptoms than those treated with a placebo. In ELEVATE, atogepant subjects were 47% less likely to develop migraine than placebo-treated subjects. And in PROGRESS, atogepant subjects were 37% less likely to develop migraine than subjects taking a placeobo.

In ADVANCE and ELEVATE, subjects taking atogepant achieved an average of one fewer day with migraine per week, compared to an average of less than one-half fewer days of migraine per week for those taking a placebo.

In PROGRESS, subjects taking atogepant achieved an average reduction of 1.5 migraine days per week compared to those taking a placebo.

Subjects taking atogepant also achieved greater improvements in scoring of the degree to which migraine impaired everyday activities as well as overall quality of life, compared to subjects taking a placebo.

The authors concluded, “Atogepant 60 mg QD demonstrated superiority to placebo in efficacy and functional measures in the first 4 weeks of treatment across 3 preventive studies, 2 in EM [episodic migraine] and 1 in CM [chronic migraine]…Atogepant-treated participants had greater reductions in the proportion of participants with a migraine day on day 1”

Lipton added, “Migraine is the second-leading cause of disability in the overall population and the leading cause of disability in young women, with people reporting negative effects on their relationships, parenting, career and finances. Having a treatment that can act quickly and effectively addresses a key need.”