Effectiveness of Zavegepant in Treating Migraine With and Without Aura: Timothy Smith, MD

WATCH TIME: 3 minutes

"Prevention medicines don’t discriminate between the two [aura vs nonaura]. We have looked at acute treatments to try to shorten aura and treat during the aura phase, but unfortunately we have never had any solid data so suggest that this strategy works."

In recent years, there have been several FDA-approved therapies to treat acute migraine, namely, calcitonin gene-related peptide (CGRP) antagonists. CGRP has been postulated to be involved in several of the pathophysiological processes of migraine, including dilation of cerebral and dural blood vessels, release of inflammatory mediators from mast cells, and transmission of nociceptive information from intracranial blood vessels to the nervous system. Erenumab (Aimovig; Sanofi), approved in 2018, was the first of its class, while zavegepant (Zavzpret; Pfizer), approved earlier this year, was the most recent to join the medication landscape.

At the 2023 American Academy of Neurology (AAN) Annual Meeting, held April 22-27, in Boston, Massachusetts, a group of investigators presented data from 2 major clinical trials of zavegepant, further highlighting the agent’s efficacy and safety. Using a cohort of 2061 patients with migraine, results showed that zavegepant outperformed placebo on the coprimary end point of 2h pain freedom in patients with aura (23.1% vs 16.6%; P = .0323) and without (23.2% vs 14.3%; P <.001) predose aura. As for achieving freedom 2h from most bothersome symptoms, the CGRP medication continued to be beneficial regardless of aura status (with predose aura: 37.5% vs 29.6%; P = .0292; without predose aura: 41.9% vs 33.4%; P <.0001). 

Lead investigator Timothy Smith, MD, chief executive officer and president of Study Metrics Research, sat down at the meeting to discuss the analysis and how it was carried out. Smith, an advisory board member of the National Headache Foundation, provided commentary on whether treating aura is approached differently, based on previously published research.

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REFERENCE
1. Smith T, Pavlovic J, Mullin K, et al. Zavegepant nasal spray for the acute treatment of migraine with aura and without aura: pooled results from 2 randomized, placebo-controlled clinical trials. Presented at: 2023 AAN Annual Meeting; April 22-27; Boston, MA. 004348.