To determine if acute treatment with rimegepant over time reduces the use of analgesics or antiemetics in adults with migraine.

Although over-the-counter and prescription analgesics and antiemetics are widely used for the acute treatment of migraine, they can be inadequate for severe attacks and have potential safety issues. Rimegepant, an FDA-approved, orally administered small molecule CGRP receptor antagonist, may reduce analgesic and/or antiemetic use during long-term treatment.

This long-term, open-label safety study (NCT03266588) included adults with a history of 2-14 monthly migraine attacks of moderate to severe pain intensity. Two dosing regimens of rimegepant 75 mg up to once daily were evaluated: (1) as needed (PRN) for 52 weeks to treat attacks of any pain intensity; and (2) every other day plus PRN (EOD+PRN) for 12 weeks. In this post-hoc analysis, use of OTC or prescription analgesics and antiemetics was analyzed during the 30-day observation period and over time in the rimegepant long-term treatment period.

Of the 1800 subjects treated (PRN [n=1514], EOD+PRN [n=286]), 89.4% were female, and mean age was 43 years. The most commonly used analgesics were ibuprofen, fixed combination acetaminophen/aspirin/caffeine, acetaminophen, and naproxen (select analgesics). The most commonly used antiemetics were ondansetron, promethazine, dimenhydrinate, meclizine, and prochlorperazine (select antiemetics). Of those who remained on study, the percentage of subjects (95% CI) who did not use select analgesics or antiemetics increased over time from 19.9% (18.2-21.9; n=1800) during the observation period to 44.6% (42.3-46.9; n=1800) during Weeks 1-4 of rimegepant treatment, 58.3% (55.9-60.6; n=1725) during Weeks 5-8, and 61.6% (59.2-63.9; n=1645) during Weeks 9-12. In the PRN group, 67.6% (64.6-70.5; n=972) of subjects did not use these medications during Weeks 49-52.

Rimegepant 75 mg up to once daily for the acute treatment of migraine substantially reduced the use of analgesics and antiemetics in adults with migraine.