P-072 - A retrospective cohort study comparing persistence between rimegepant and oral triptans for the acute treatment of migraine in the United States.

Abstract Title: A retrospective cohort study comparing persistence between rimegepant and oral triptans for the acute treatment of migraine in the United States.

Background: Migraine is a prevalent, disabling chronic disease with significant burden on patients, caregivers and health care system [1]. Treatment is traditionally considered as either acute (taken pro re nata (PRN) to minimise symptom impact) or preventative (taken regularly to reduce attack frequency and severity).

Rimegepant 75mg, is an oral calcitonin gene-related peptide antagonist; in many countries, it is the first treatment approved for both acute and preventative treatment of migraine.



Current standard of care for the acute treatment of migraine are triptans. While generally effective, they do not work for all patients due to poor tolerability or insufficient effectiveness. Persistence of acute treatment is important for effective disease management and may provide insights into treatment tolerability and satisfaction of patients. However, assessing persistence in PRN medicines is challenging due to intra- and inter-patient variability in frequency of use.

Purpose/Objectives: Compare the proportion of persistent patients between cohorts receiving rimegepant and oral triptans in the United States (US).

Subgroup analyses compared the proportion of persistent patients in rimegepant cohort with specific triptans (rizatriptan, sumatriptan) and in chronic migraine patients.


Methods: A retrospective cohort analysis of a large administrative claims data base from the US (MarketScan) was performed.

Adults diagnosed with migraine were included who were new users of rimegepant (assumed as quantity 8 pills to differentiate from preventative use) or oral triptans (30 days supply) with a minimum of 12 months follow up. Index date was defined as the date of initial prescription (1 March 2020 to 30 June, 2023). New users were identified using a look back period of 12 months prior to index. Baseline demographics and clinical characteristics of the cohorts were described.

To include low migraine frequency patients in the analysis, persistence was defined as the proportion of patients with a repeat prescription of the index treatment within 12 months.

To address confounding, 1:1 propensity score matching was used, persistence was compared between matched cohorts using odds ratio (OR) with 95% confidence intervals (95% CI) and associated p-value.


Results: Prior to matching, the rimegepant and triptan cohorts included 13,599 and 38,127 patients respectively. The rimegepant cohort tended be older than the triptan cohort (mean age 43.2 vs 39.5 yrs), with a greater proportion of females (87.8% vs 82.0%). The rimegepant cohort also had a greater proportion of patients with ≥1 triptan contraindications or ≥2 cardiovascular risk factors (49.7% vs 36.9%), proportion of patients with any Elixhauser comorbidities (74.0% vs 64.5%). Reflecting prior authorisation requirements, rimegepant patients tended to have greater previous use of acute treatments (NSAIDs: 34.2% vs 24.8%; opioids and combinations: 30.1% vs 20.9%) and a greater proportion of patients with ≥1 prior conventional oral preventative treatments (59.7% vs 29.0%).

After matching, the baseline characteristics were similar (standardised difference < 0.1). The primary analysis included 9,909 patients per cohort. Significantly more patients were identified as persistent in the rimegepant cohort compared to the triptan cohort (75.8% and 53.5% respectively; OR 2.72, 95% CI 2.56, 2.90, p< 0.001). Similar results were seen in the subgroup analyses; rimegepant vs oral rizatriptan (8,747 patients per cohort): OR 2.49 (95% CI 2.33, 2.67, p< 0.001); rimegepant vs oral sumatriptan (9,046 patients per cohort): OR 2.92 (95% CI 2.73, 3.12, p< 0.001); rimegepant vs oral triptans in chronic migraine (2,935 patients per cohort): OR: 2.86 (95% CI 2.53, 3.23, p< 0.001). Results were robust to sensitivity analyses exploring changes in the duration of follow-up used: 6 months follow-up available required for rimegepant vs oral triptans (14,266 per cohort): OR 2.72 (95% CI 2.59, 2.87, p< 0.001); 18 months follow-up available required for rimegepant vs oral triptans (6,399 patients per cohort): OR: 2.75 (95% CI 2.53, 2.98, p< 0.001). A sensitivity analysis requiring 2 repeat prescriptions in a 12-month follow-up period instead of 1 also showed significantly greater persistence for the rimegepant cohort vs oral triptans (9,909 per cohort): OR: 3.26 (95% CI 3.06, 3.48, p< 0.001).

Conclusions/Implications for future research and/or clinical care: Patients from the rimegepant cohort were significantly more likely to be persistent than patients in the triptan cohort, regardless of specific triptan taken or chronic migraine status.

These results may reflect a better response and/or tolerability of rimegepant treatment compared to that of oral triptans.


References: 1. Bonafede M, Cai Q, Cappell K, et al. Factors associated with direct health care costs among patients with Migraine. Journal of Managed Care and Specialty Pharmacy. 2017;23(11):1169-1176.