Atogepant's Impact on Chronic Migraine, LD/CD Intra-Oral Pump Improves ON Time, Ravulizumab Effective in NMOSD Subgroups


Neurology News Network for the week ending April 30, 2023. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. This week’s episode is dedicated to research presented at the 2023 American Academy of Neurology Annual Meeting.

Weeks after the FDA expanded the indication for atogepant (Qulipta; AbbVie) to include the treatment of chronic migraine, findings presented at the 2023 American Academy of Neurology (AAN) Annual Meeting further supported its efficacy. The data presented was from the phase 3 PROGRESS study (NCT03855137), a 12-week trial that was the basis for the expanded indication. Led by Patricia Pozo-Rosich, MD, PhD, PROGRESS included 778 individuals with chronic migraine who were randomly assigned to either atogepant 30 mg twice daily (BID), 60 mg once daily (QD), or placebo. Like many migraine studies, the primary end point was change from baseline in mean monthly migraine days (MMDs), with proportion of patients experiencing at least 50% reduction in 3-month average of MMDs as the secondary end point. At the end of the 12-week treatment period, patients on atogepant 30 mg BID and 60 mg QD experienced mean change in MMDs of ­–7.5 and –6.9 days, respectively, compared with changes of –5.1 for those on placebo.

Administration of levodopa/carbidopa (LD/CD) via an intra-oral pump resulted in significantly improved ON time without dyskinesia as well as OFF time in patients with Parkinson disease. Liquid LD/CD is delivered continuously from the pump for 5 to 6 hours directly into the saliva and swallowed, allowing patients to avoid invasive infusion pumps and other less-than-ideal administrations. The nonrandomized, open-label study, which included 16 participants, assessed variability in plasma levodopa levels between the theDopaFuse pump and standard intermittent levodopa; the effect on motor function, including OFF time, ON time without severe dyskinesia, and ON time without any dyskinesia; as well as safety and tolerability of theDopaFuse system.

In a prespecified analysis of the CHAMPION-NMOSD open-label, phase 3 study, findings displayed ravulizumab (Ultomiris; Alexion) was superior in antiaquaporin (AQP4) antibody-positive neuromyelitis optica spectrum disorder (NMOSD) compared with placebo in prespecified subgroups by age, sex, race and geographic region. The treatment was superior in preventing on-trial relapse in monotherapy and immunosuppressive therapy groups compared with placebo based on time to first adjudicated on-trial relapse. Notably compared with placebo, significant differences were observed in patients who had previously received rituximab.

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