#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines
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- Results statistically significant unless stated.
- 11 systematic reviews1-11 of the same 2-3 industry-funded randomized controlled trials (RCTs).12-14 Participants with 2-8 migraines/month (with or without aura) given ubrogepant or placebo for acute moderate-severe migraine.
- Focusing on one systematic review1 of all 3 RCTs (25-100mg) with usable ubrogepant results (3326 participants, ∽24% on prophylaxis (non-CGRP):12,13
- Pain free at 2 hours: 21% versus 13% (placebo).
- No difference between 25, 50 and 100mg doses.
- Relief at 2 hours (from moderate/severe pain to mild/no pain): 61% versus 49% (placebo).
- Absence of the most bothersome symptom at 2 hours: 37% versus 28% (placebo).
- Normal functioning at 2 hours: 42% versus 32% (placebo).
- Sustained pain relief at 24 hours: 37% versus 22% (placebo).
- Pain free at 2 hours: 21% versus 13% (placebo).
- Limitations: Single dose trials, industry funded.
- Other systematic reviews showed similar.2-11
- No difference in adverse events.1-3,7 One systematic review3 found more ear, nose and throat-related adverse events but no absolute numbers reported.
- Focusing on one systematic review1 of all 3 RCTs (25-100mg) with usable ubrogepant results (3326 participants, ∽24% on prophylaxis (non-CGRP):12,13
- A one-year, open-label RCT evaluated safety of ubrogepant versus usual care (1230 participants, 31968 doses).15
- Discontinuation due to adverse events 2-3% with ubrogepant, similar to usual care. No statistical comparison.
- Ubrogepant (Ubrelvy®) is the only CGRP antagonist approved in Canada for acute migraine treatment.16 Costs ∽$15/dose.17
- No direct comparison available but triptans appear more effective (∽30-40% pain free at 2 hours versus 21% [ubrogepant]).1,3,4,11,18
- Response to ubrogepant independent from response to triptans.19,20
- Based on 1 RCT, ubrogepant likely effective at preventing headache when taken during prodrome (no moderate-severe headache at 24 hours: 46% versus 29% [placebo]).21
- Efficacy in chronic migraines,12,13 role with concomitant prophylactic CGRP antagonists,22,23 long-term safety,24,25 safety in people with cardiovascular disease26,27 unclear.