Rimegepant for Acute Migraine May Reduce Use of, Reliance on Opioids: New Data

Opioid refills were reduced by ~40% in the 9 months following an initial prescription for rimegepant among patients with migraine, a new study found.

Use of rimegepant (Nurtec ODT, Biohaven), an orally dissolving calcitonin gene-related peptide (CGRP) receptor antagonist approved for acute treatment of migraine, may help patients discontinue use of opioids to treat the disease, reducing the potential for negative outcomes.

The suggestion is based on findings of a real-world study including records of more than 14 000 adults with migraine who used opioids prior to initiating treatment with rimegepant. Nine months after beginning treatment with the CGRP inhibitor, approximately 41% of patients had no opioid prescription refills.

"The acute treatment of migraine is an evolving landscape with more specific, novel treatments available to patients, said lead author Noah Rosen, MD, Northwell Physician Partners, Neuroscience Institute of Great Neck, NY in a news release from Biohaven Pharmaceuticals. “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." Rosen presented the findings during a symposium at the American Association of Neurology (AAN) 2022 Annual Meeting.

Investigators used longitudinal data from an integrated commercial medical and prescription claims database to create the study population. For inclusion patients were required to have 18 months of observation data, at least 1 opioid prescription fill during the baseline period, and at least 2 prescription fills for rimegepant during the follow-up period. In order to describe comedication use, Rosen et al also conducted a sub-cohort analysis of current and past/or non-triptan users.

The population for analysis numbered 14 019 and included 6580 patients with a history of past or non-triptan use and 7439 currently using triptans. The overall opioid discontinuation rate in the 9 months following Rimegepant initiation was 40.5% with similar findings for both triptan subcohorts (past/no triptan use 39.7%; current triptan use 41.3%).

For the full study population, mean monthly opioid prescription refills decreased by 16.1% (P<.001) and morphine milligram equivalents fell by 2.8% (P<.001). The researchers reported for the subcohort analyses a trend of decreasing use in both, with refills decreased by 15.3% and 16.8% (both P<.001) among triptan non/past and current use patients, respectively.

"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,” observed study co-author Gil L'Italien PhD, senior vice president, GHEOR & epidemiology, Biohaven, in the statement. “Our findings support the benefit of Nurtec ODT as an effective and safe migraine treatment that can reduce the need for opioids."

The World Health Organization classifies migraine as one of the 10 most disabling medical illnesses.

The US Food and Drug Administration approved rimegepant for acute treatment of migraine in February 2020 and for prevention of episodic migraine in May 2021.