AAN 2022 | Novel options: atogepant and rimegepant for preventing migraines

Jessica Ailani, MD, MedStar Georgetown University Hospital, Georgetown, Washington, DC, describes two new oral treatment options for preventing migraines: atogepant and rimegepant. These are calcitonin gene-related peptide (CGRP) receptor antagonists (gepants), adding to the treatment options for many patients, especially women who are considering pregnancy. The problem with injectable anti-CGRP monoclonal antibodies is that women must stop the treatment five months before starting to try for pregnancy, meaning they would suffer from migraines in the time in-between, throughout pregnancy, and until completing lactation. The gepants are beneficial as they reduce the time following cessation before it is possible to try for pregnancy and can be used to bridge the gap between coming off antibody treatment to pregnancy. Patients who struggle with injections also benefit from this oral option. Lastly, some patients that did not respond to available monoclonal antibodies unexpectedly responded to gepants and vice versa, revealing a whole branch of biology that needs to be investigated. Although it was previously assumed that both treatments work in the same way (i.e., by blocking CGRP), these results suggests that there is more than one mechanism underlying their activity in migraines and clinical benefit can arise from targeting secondary mechanisms. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.