Richard B. Lipton, MD

“Treating migraine is a huge opportunity to be helpful to patients and our tools have never been better. Although it can take some effort to treat migraine, it's, really, really gratifying. And with all the new tools we have available, it's possible to make a big difference in our patients’ lives.”

Rimegepant (Nurtec ODT; Biohaven), previously approved for the treatment of acute migraine in February 2020, has shown 

 when taken every other day in a recent multicenter, phase 2/3, randomized, double-blind, placebo-controlled trial (NCT03732638).

Researchers found a clinically significant, at least 50% reduction in the mean number of moderate or severe migraine days per month in the last month of double-blind treatment in around 49% (n = 171; 95% CI, 44-54) of patients on rimegepant as compared to 41% (n = 142; 95% CI, 36-47) of patients on placebo.

 spoke with study coauthor Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center to learn more about the advances in migraine treatment. He stressed the impact that alleviating migraine can have on patients.

1. Kroop R, Lipton RB, Kudrow D, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. 

. 2021:397(10268):51-60 doi: 10.1016/S0140-6736(20)32544-7
2. Rimegepant Approved by FDA for the Acute Treatment of Migraine in Adults. News release. February 27, 2020. Accessed February 22, 2021. https://americanheadachesociety.org/news/rimegepant-acute-migraine-treatment/

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The director of the Montefiore Headache Center discussed recent advances in treating migraine both acutely and preventively.  

Impact of Alleviating Migraine: Richard B. Lipton, MD

“I’d like to know a little bit more about how rimegepant works, a little bit more about the precise mechanism. I'd like to know if calcitonin gene-related peptide antagonists work on headache types other than migraine, like post traumatic headache, which looks a whole lot like migraine but is initiated by head injury.”

Data from a recent multicenter, phase 2/3, randomized, double-blind, placebo-controlled trial (NCT03732638) suggest that rimegepant (Nurtec ODT; Biohaven), previously approved for the treatment of acute migraine in February 2020, is 

Study coauthor Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, and colleagues found that patients on rimegepant, a calcitonin gene-related peptide (CGRP) antagonist, had a least square mean change of –3.6 (95% CI, –4.0 to –3.2) in the number of total migraine days per month over the 3-month treatment period as compared to –2.7 (95% CI, –3.1 to –2.3; 

reached out to Lipton to learn more about his thoughts on the potential of CGRP antagonists in preventing migraine. He also discussed further research he would like to see conducted, including investigating the mechanism of rimegepant further and combination therapies.

The director of the Montefiore Headache Center discussed the research he would like to see into the treatment, including the potential of combination approaches. 

Further Research on Rimegepant for Migraine Prevention: Richard B. Lipton, MD

“A lot of people don't want injections. That's one challenge. The other challenge is other drugs have a half-life of about a month... Rimegepant has a 12-hour half-life, so it's 95% out of your body in 3 days. So, it's better for women of childbearing potential, it's better since the drug doesn't require an injection.”

Data from a recent multicenter, phase 2/3, randomized, double-blind, placebo-controlled trial (NCT03732638) suggest that rimegepant (Nurtec ODT; Biohaven) is 

 The medication was previously approved for the treatment of acute migraine in February 2020.

Researchers, including study coauthor Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, found that 49% (95% CI, 44-54; n = 171) of patients on rimegepant had at least a 50% reduction in the mean number of moderate or severe migraine days per month in the last month of double-blind treatment as compared to 41% (95% CI, 36-47; n = 142) of patients on placebo.

 reached out to Lipton to learn more about rimegepant’s potential to both treat and prevent migraines. Lipton compared rimegepant for migraine prevention to the monoclonal antibodies, the current standard for migraine prevention. 

. Published online December 15, 2020. doi: 10.1016/S0140-6736(20)32544-7
2. Rimegepant Approved by FDA for the Acute Treatment of Migraine in Adults. News release. February 27, 2020. Accessed February 22, 2021. https://americanheadachesociety.org/news/rimegepant-acute-migraine-treatment/

The director of the Montefiore Headache Center discussed how rimegepant has certain benefits over monoclonal antibodies, such as a much shorter half-life. 

Rimegepant vs. Monoclonal Antibodies for Migraine Prevention: Richard B. Lipton, MD

“What I say to patients is, ‘there's a 50% chance that you're going to have at least a 50% reduction in the number of headache days you have per month.’ And if you go from 8 days a month to 4 days a month, and you have something that you can take that also works acutely, that can be life changing for people.”

Rimegepant (Nurtec ODT; Biohaven), approved for the treatment of acute migraine in February 2020, has also been shown to be 

A recent multicenter, phase 2/3 randomized, double-blind, placebo-controlled trial (NCT03732638) found that 49% (95% CI, 44-54; n = 171) of patients on rimegepant had at least a 50% reduction in the mean number of moderate or severe migraine days per month in the last month of double-blind treatment as compared to 41% (95% CI, 36-47; n = 142) of patients on placebo.

reached out to study coauthor Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, and colleagues, to learn more about rimegepant’s efficacy in preventing migraine. Lipton also discussed the clinical importance of a 50% reduction in headache days.

1. Kroop R, Lipton RB, Kudrow D, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial.

. Published online December 15, 2020. doi: 10.1016/S0140-6736(20)32544-7
2. Rimegepant Approved by FDA for the Acute Treatment of Migraine in Adults. News release. February 27, 2020. Accessed January 6, 2021. https://americanheadachesociety.org/news/rimegepant-acute-migraine-treatment/

The director of the Montefiore Headache Center discussed the impact of halving headache days for patients with migraine. 

Richard B. Lipton, MD

Articles

Impact of Alleviating Migraine: Richard B. Lipton, MD

Further Research on Rimegepant for Migraine Prevention: Richard B. Lipton, MD

Rimegepant vs. Monoclonal Antibodies for Migraine Prevention: Richard B. Lipton, MD

Cutting Down Monthly Headache Days in Migraine: Richard B. Lipton, MD