Susan Hutchinson, MD: The Potential of the Gepant Class in Acute Migraine


The director of the Orange County Migraine and Headache Center spoke about the adherence issues in acute migraine treatment and how the safety profile of investigational medications such as rimegepant and ubrogepant suggests they may be able to address them.

“If you look at the clinical trials and the AEs—adverse events—we’re not seeing the flushing, the chest tightness, the neck tightness, and we’re also seeing some pretty good efficacy when you look at things like 2-hour pain relief and relief of most bothersome symptom. It appears that the oral gepants could be as efficacious as the triptans, but with a much more favorable [safety] profile.”

Acute migraine therapy classes such as the triptans, of which sumatriptan is considered somewhat of the gold standard, while efficacious in the treatment of migraine attacks, are often accompanied by unwanted adverse events (AEs) in the patients who use them. Although they don’t occur in every patient, their presence has led to increasing rates of poor adherence to medications, with some patients even being driven toward opioids and other painkillers to handle acute migraine attacks.

Now, however, a new glass of oral calcitonin gene-related peptide (CGRP) antagonists including rimegepant, ubrogepant, and atogepant, have displayed somewhat comparable efficacy in clinical trials without the high rates of AEs such as cardiovascular issues. It seems, pending regulatory approval, that these medicines hold the potential to help fill in the gaps for those individuals for who triptans are unsuccessful.

To find out more about these therapies and the reasons why patients fail to use their acute medications, NeurologyLive spoke with Susan Hutchinson, MD, director, Orange County Migraine and Headache Center, about these therapies at the 2019 American Headache Society (AHS) Annual Meeting, July 11-14, 2019, in Philadelphia, Pennsylvania.

For more coverage of AHS 2019, click here.

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