Atogepant for migraine in real-world clinical practice: Insights from a large multicentre study in a treatment-resistant population (GEMA project) - PubMed

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Atogepant, a novel oral CGRP receptor antagonist, was evaluated in a real-world clinical study for migraine prevention in a treatment-resistant population.
The study involved 513 patients (mean age 48, 88% women) across 15 centers in Spain, with treatment-resistant migraine defined as failure of at least three classes of preventive medications.
At 3 months, median monthly headache days decreased from 21 to 14 and monthly migraine days from 14 to 8, with ≥50% reduction achieved by 34% and 29% of patients, respectively.
Adverse events were mostly mild, primarily constipation (30%) and nausea (18%), with a 3-month discontinuation rate of 11.8%.
Better outcomes were associated with shorter migraine chronicity, less analgesic overuse, and fewer prior preventive failures; prior inadequate response to anti-CGRP mAbs did not prevent meaningful benefit.
At 6 months, further improvement was observed with median monthly headache days at 10 and monthly migraine days at 6, alongside fewer adverse events.
The study supports the earlier introduction of anti-CGRP therapies like atogepant in clinical practice due to its robust effectiveness and good tolerability.

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