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New Acute-Migraine Therapy Shows Promise

A drug belonging to a new generation of acute-migraine treatments eliminated pain and reduced bothersome symptoms for people with migraine in a large-scale trial reported in the July 11 issue of The New England Journal of Medicine. The drug, rimegepant, may offer advantages over currently available migraine medications.

The study’s first author was Richard B. Lipton, M.D., the Edwin S. Lowe Chair and vice chair of the Saul R. Korey Department of Neurology at Einstein and director of the Montefiore Headache Center.

Currently, many people with migraine take triptan drugs (such as sumatriptan, eletriptan, and rizatriptan), which were introduced in the 1990s. People not helped by triptans, or who can’t take them, may benefit from the new class of drugs called gepants, which includes rimegepant.

Gepants work by targeting the receptors for a small protein, called CGRP, long implicated in migraine. During migraine attacks, CGRP is released, resulting in pain. Gepants relieve the pain and other symptoms of migraine by blocking the CGRP pathway.

Rimegepant was assessed in a randomized, double-blind trial involving more than 1,000 men and women with migraine at 49 centers in the United States. Each participant took a tablet of rimegepant or a matching placebo tablet during a migraine attack. Two hours after taking their tablets, 19.6% of patients in the rimegepant group were free from pain, compared with 12% in the placebo group—a statistically significant difference. Freedom from their most bothersome symptoms occurred in 37.6% of patients in the rimegepant group and 25.2% in the placebo group.

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