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. 2024 Sep 27:15:1468961.
doi: 10.3389/fneur.2024.1468961. eCollection 2024.

Atogepant for migraine prevention: a meta-analysis of safety and efficacy in adults

Adarsh Raja  1 , Rabia Asim  1 , Muhammad Hamza Shuja  2 , Sandesh Raja  2 , Tazheen Saleh Muhammad  1 , Simran Bajaj  3 , Abdul Hadi Ansari  1 , Hamza Ali  1 , Iffat Ambreen Magsi  1 , Muhammad Hammad Faridi  1 , Hamza Ali Hasnain Sheikh  1 , Muhammad Junaid Imran  1 , Muhammad Ahmed  1 , Muhammad Sohaib Asghar  4   5
Affiliations

Atogepant for migraine prevention: a meta-analysis of safety and efficacy in adults

Adarsh Raja et al. Front Neurol. .

Erratum in

Abstract

Background: Migraine is a neurological condition marked by frequent headaches, which tends to be accompanied by nausea and vomiting in severe instances. Injectable therapies for migraine, such as monoclonal antibodies that target calcitonin gene-related peptide (CGRP), have proven to be effective and safe. While various oral drugs are available, none have been developed for migraines. Patients prefer oral therapies because they are easier to use, making atogepant, an orally accessible small-molecule CGRP receptor antagonist, a possible alternative.

Objectives: This systematic review and meta-analysis compared the safety and effectiveness of atogepant with placebo in treating migraine.

Methods: Adhering to the PRISMA guidelines, we meticulously gathered randomized controlled trials (RCTs) from databases including the Cochrane Library, PubMed, Science Direct, and ClinicalTrials.gov. Studies comparing atogepant with placebo and reporting monthly migraine days (MMDs) as the primary outcome along with secondary outcomes such as monthly headache days and acute medication use days were included. Two independent reviewers conducted the data extraction and quality assessment. Statistical analyses were carried out using RevMan, utilizing risk ratios for dichotomous outcomes and mean differences for continuous outcomes, and a random-effects model.

Results: Our primary outcome was the change in MMDs over 12 weeks, which showed a significant reduction with atogepant at dosages of 10, 30, and 60 mg. Secondary outcomes, such as monthly headache days, proportion of patients achieving a ≥ 50% reduction in MMDs, acute medication use days, and patient-reported outcomes, consistently showed that atogepant outperformed placebo, highlighting its effectiveness in reducing the migraine burden.

Conclusion: Higher doses of atogepant are more effective in lowering migraine and headache-related days and increasing quality of life metrics. However, this is accompanied by an increased incidence of adverse events, suggesting the need for careful dose optimization to balance the benefits and risks.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=563395. Unique Identifier: CRD42024563395.

Keywords: CGRP; atogepant; headache; meta-analysis; migraine.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Prisma flow chart.
Figure 2
Figure 2
(A) Risk of bias graph. (B) Risk of bias summary.
Figure 3
Figure 3
Forest plot of change in monthly migraine days.
Figure 4
Figure 4
Forest plot of change in monthly headache days.
Figure 5
Figure 5
Forest plot of ≥50% reduction in monthly migraine days.
Figure 6
Figure 6
Forest plot of acute medication use days.
See this image and copyright information in PMC

References

    1. Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. (2022) 23. doi: 10.1186/s10194-022-01402-2 - DOI - PMC - PubMed
    1. Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, et al. . Diagnosis and management of migraine in ten steps. Nat Rev Neurol. (2021) 17:501–14. doi: 10.1038/s41582-021-00509-5, PMID: - DOI - PMC - PubMed
    1. Buse DC, Reed ML, Fanning KM, Bostic RC, Lipton RB. Demographics, headache features, and comorbidity profiles in relation to headache frequency in people with migraine: results of the American migraine prevalence and prevention (AMPP) study. Headache. (2020) 60:2340–56. doi: 10.1111/head.13966, PMID: - DOI - PubMed
    1. Goadsby PJ, Edvinsson L, Ekman R. Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Ann Neurol. (1990) 28:183–7. - PubMed
    1. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the quality standards Subcommittee of the American Academy of neurology and the American headache society. Neurol Int. (2012) 78:1337–45. doi: 10.1212/WNL.0b013e3182535d20 - DOI - PMC - PubMed

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