Sait Ashina, MD, Harvard Medical School, Boston, MA, discusses the advantages of using oral anti-CGRP drugs instead of injectable ones in migraine prevention. Currently, two oral CGRP antagonists are approved by the FDA for migraine prevention: atogepant and rimegepant. Orals CGRP antagonists are proven to be effective for preventing migraine – data support the use of both agents and show solid and sustained responses. Atogepant and rimegepant have a tolerable safety profile, and although safety concerns remain, they are fewer than with injectable monoclonal antibodies (mAbs) due to their shorter half-life. One of the main advantages highlighted by Dr Ashina is the ease of prescribing oral agents compared with injectables. Importantly, most patients with migraine in the US are seen by primary care physicians, and a study has shown that oral triptans are widely prescribed by primary care physicians, possibly because of the convenience of oral agents: easier for the clinician to prescribe and instruct the patients how to use it. Additionally, the administration of oral agents is easier than injectables, and it avoids the issue of needle phobia, a relevant and neglected factor, as well as injection-site reactions. It is also important to note that rimegepant can be used for the acute and preventive treatment of migraine. This interview was conducted during the 2022 World Congress on Controversies in Neurology (CONy) meeting.
Dr Ashina is a consultant for Allergan/AbbVie, Amgen, Biohaven, Eli Lilly, Impel NeuroPharma, Novartis, Satsuma, Supernus, Theranica and Percept.