Opioid Use Significantly Decreased on Rimegepant Regimen, Real-World Claims Suggest
Among triptan non/past use and current use patients, investigators observed refill decreases of 15.3% and 16.8%, respectively, in the 9 months following rimegepant treatment.
Noah Rosen, MD
A real-world administrative claims study presented at the 2022 American Academy of Neurology (AAN) Annual Meeting, April 2-7, in Seattle, Washington, showed that treatment with rimegepant (Nurtec ODT; Biohaven Pharmaceuticals) was associated with significant decrease in opioid use among patients with migraine.1,2
Among a sample of 14,109 eligible patients with migraine treated with rimegepant, those with no prior triptan exposure demonstrated a 16.06% decrease in total opioid Rx fills and a 2.84% decrease in mean monthly morphine milligram equivalents (MME) dispensed over 9 months since initiation (both P <.0001). These results suggest that rimegepant, an oral calcitonin gene-related peptide (CGRP) antagonist, may be of benefit to those reliant on opioids to manage their disease, thereby alleviating potential negative consequence of opioid use.
Lead investigator and presenter Noah Rosen, MD, director, Headache Center, Northwell Health, said in a statement, "The acute treatment of migraine is an evolving landscape with more specific, novel treatments available to patients. This study demonstrated in a real-world manner that when people are given a new effective option for their migraines that there is a meaningful reduction in the population's use of opiates."1
To be included in the study, patients required 18 months of total follow-up, time aligned with rimegepant initiation at the midpoint, at least 2 rimegepant fills, and at least 1 opioid fill in the 9-month prerimegepant-initiation baseline period. Approved originally as an acute treatment in 2020 and as a preventative for episodic migraine in 2021, rimegepant led to an overall opioid discontinuation rate of 40.5%. These results were also similar for those with a history of non/past triptan use (39.7%; n = 6580) and those with current triptan use (41.3%; n = 7439).
"Administrative claims provide a rich source of data on treatment patterns associated with the introduction of novel medications, and the duration of follow-up affords the opportunity to assess trends associated with these transitions,” Gil L’Italien, PhD, senior vice president, GHEOR & Epidemiology, Biohaven, said in a statement.1 “Our findings support the benefit of Nurtec ODT as an effective and safe migraine treatment that can reduce the need for opioids."
Overall, mean monthly MME dispensation trended upward before rimegepant and downward following treatment initiation. For patients with no triptan exposure prior to Rimegepant initiation, investigators observed decreases of 15.23% and 1.72% in prescription fills and mean monthly MME dispensed, respectively.2
In February 2020, the orally disintegrating anti-CGRP tablet was approved in 75-mg doses for the acute treatment of migraine—the first approval of a therapy for Biohaven. Over a year later, in May 2021, the FDA approved an expanded indication for the medication to include the preventive treatment of migraine, marking it as the first oral CGRP antagonist to be approved for both indications.3
In a recent NeurologyLive Peer Exchange™, a panel of neurologists reviewed clinical trial data on several CGRP monoclonal antibodies, including rimegepant, for migraine preventive treatment. Watch below as experts—including Jessica Ailani, MD, and Andrew Charles, MD, and others—compared the efficacy and safety data of each medication.
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