ArticleNeurology and therapy2026
Real-World Effectiveness and Tolerability of Rimegepant as Second- or Third-Line Acute Treatment for Migraine: A Prospective Observational Study.
Article in Neurology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionRimegepant is an oral calcitonin gene-related peptide receptor antagonist approved for both acute and preventive treatment of migraine. However, limited information is available regarding its effectiveness and tolerability when used as a second- or third-line acute treatment in patients for whom triptans and/or lasmiditan are ineffective, poorly tolerated, contraindicated, or otherwise unsuitable. This study evaluated the effectiveness and tolerability of rimegepant in this real-world clinical setting.
methodsA prospective observational study was conducted in 89 patients (76 female; mean age 40.6 ± 12.2 years) prescribed rimegepant 75 mg after prior use of triptans and/or lasmiditan. Participants self-recorded headache intensity using a visual analog scale (VAS) before and 2 and 4 h after taking rimegepant. Pain freedom was defined as a VAS score of 0, and treatment efficacy as a ≥ 50% reduction in VAS score. The Patient Global Impression of Change (PGIC) was assessed at 2 h. Continuation was defined as a request for ongoing prescription after the initial dose.
resultsThe study population included 35 patients (39.3%) with chronic migraine and 65 (73.0%) with prior calcitonin gene-related peptide (CGRP) monoclonal antibody exposure. Median VAS scores decreased from 77.0 at baseline to 18.0 at 2 h and 0.0 at 4 h (p < 0.001). Pain-free rates were 24.7% (95% CI 16.2-35.0%) at 2 h and 52.8% (95% CI 41.9-63.5%) at 4 h. Efficacy rates (≥ 50% VAS reduction) were 68.5% and 87.6% at 2 and 4 h, respectively. The continuation rate was 82.0%. Meaningful improvement on the PGIC was reported by 65.2% of patients. Adverse events occurred in 13.5% of patients. No adverse events leading to treatment discontinuation were observed.
conclusionRimegepant was associated with clinically meaningful pain relief and favorable patient-reported outcomes when used as a second- or third-line acute treatment in real-world clinical practice.
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