P-103 - Satisfaction with treatment outcomes in people with migraine receiving rimegepant or triptans: a descriptive analysis from a real-world migraine tracking app

Abstract Title: Satisfaction with treatment outcomes in people with migraine receiving rimegepant or triptans: a descriptive analysis from a real-world migraine tracking app

Background: Migraine is a prevalent and often debilitating neurological disorder that affects millions of people worldwide. It is characterized by recurrent, severe headaches typically accompanied by other symptoms such as nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound (phonophobia)¹. These symptoms can significantly impair the quality of life and productivity of individuals who suffer from migraines. Effective and timely acute treatment options are essential for managing these attacks and minimizing their impact on daily activities. Triptans, a class of serotonin receptor agonists, are commonly used to provide acute relief from migraine symptoms. Rimegepant (Nurtec), a calcitonin gene-related peptide (CGRP) receptor antagonist, belongs to the newest class of gepant migraine treatments. In China, triptans are the most relevant comparator to rimegepant for the acute treatment of migraine. Although efficacy may be similar, rimegepant could offer tolerability and safety advantages. This study aims to compare patient satisfaction with these two types of medications to treat migraine, focusing on multiple dimensions including pain intensity, attack duration, speed of action, cognitive impact, other symptoms, and overall tolerability.

Purpose/Objectives: The primary objective of this study is to assess the benefit of rimegepant compared to triptans on various dimensions of migraine attacks using real-world data. Specifically, it seeks to evaluate patient satisfaction with regards to medication effectiveness (pain intensity, attack duration, speed of action, cognitive impact, other symptoms) and tolerability in adults diagnosed with migraine who are using rimegepant and/or triptans as an acute treatment for migraine.

Methods: This retrospective analysis involved a cross-sectional examination of data collected via the Migraine Buddy app between October 20, 2023, and May 20, 2024. The Migraine Buddy app is a widely used tool for tracking headache symptoms and treatment outcomes, with over 3.7 million downloads globally². Participants included U.S. users of the app who reported current use of an acute migraine treatment and completed a satisfaction survey administered through the app. Data were extracted from users who reported using Nurtec and/or a triptan, in particular rizatriptan, which is the most commonly prescribed triptan in China. Satisfaction levels were measured on a 7-point Likert scale, ranging from ‘extremely dissatisfied’ (1) to ‘extremely satisfied’ (7). If a patient is using more than one acute treatment, they are able to complete satisfaction questions separately for each acute treatment. Respondents were categorized into three groups based on their responses for reporting and comparisons: ‘satisfied’ (extremely satisfied/satisfied), ‘neutral’ (slightly satisfied/neither satisfied or dissatisfied/slightly dissatisfied) and ‘dissatisfied’ (dissatisfied/extremely dissatisfied). Descriptive statistics were used to summarize the data, and comparative analyses were conducted to evaluate differences in satisfaction between rimegepant and triptans by two-sample proportion test. Respondents who reported being ‘extremely satisfied’ were also evaluated.

Results: A total of 1,558 responses were analyzed, with 708 responses from rimegepant users and 845 from triptan users, 72% rizatriptan. Higher satisfaction among rimegepant users was identified across various dimensions: Pain Intensity: the ‘satisfied’ group represented 76.13% of rimegepant respondents, which was 2.17% above respondents for the triptan group (73.96%) (p = 0.357). 38.6% of rimegepant users reported being ‘extremely satisfied’ compared to 27.1% of triptan users, indicating a difference of +11.5% (p < 0.001). Attack Duration: the ‘satisfied’ group represented 74.01% of respondents in the rimegepant group, 6.44% higher than respondents for the triptan group (67.57%) (p = 0.007). 42.2% of rimegepant users were ‘extremely satisfied’ compared to 29.1% of triptan users (+13.1% difference (p < 0.001)). Speed of Action: the ‘satisfied’ group represented 71.47% of respondents in the rimegepant group, 9.46% above respondents for the triptan group (62.01%) (p < 0.001). 26.1% of rimegepant users were ‘extremely satisfied’ compared to 18.6% of triptan users, reflecting a difference of +7.5% (p < 0.001). Cognitive Impact: the ‘satisfied’ group represented 60.73% of respondents in the rimegepant group, which was 15.29% above respondents for the triptan group (45.44%) (p < 0.001). 20.9% of rimegepant users were ‘extremely’ satisfied compared to 12.1% of triptan users (+8.8% difference (p < 0.001)). Other Symptoms: the ‘satisfied group’ represented 59.04% of respondents in the rimegepant group, which was 2.47% higher than respondents for the triptan group (56.57%) (p = 0.352). 17.9% of rimegepant users were ‘extremely satisfied’ compared to 14.7% of triptan users, showing a difference of +3.3% (p = 0.095). Tolerability: the ‘satisfied’ group represented 86.13% of respondents in the rimegepant group, which was 20.57% above respondents for the triptan group (65.56%) (p < 0.001). 60.2% of rimegepant users were ‘extremely satisfied’ with tolerability compared to 32.0% of triptan users, a substantial difference of +28.2% (p < 0.001).

Overall, satisfaction with rimegepant was higher than for triptans (statistically significant, except for pain intensity and other symptoms), and in particular when comparing those reporting being ‘extremely satisfied’. The largest differences between rimegepant and triptans were observed for satisfaction with reducing cognitive impact and with the tolerability of treatment.

Conclusions/Implications for future research and/or clinical care: The findings from this study indicate that rimegepant offers higher overall patient satisfaction compared to triptans for acute migraine treatment. Patients using rimegepant reported higher levels of satisfaction across several key dimensions. The significant differences in satisfaction levels, especially with respect to tolerability and reducing cognitive impact, indicate that rimegepant may provide a more favorable treatment experience for patients. Future research should consider long-term comparative studies to further elucidate the benefits and potential limitations of rimegepant relative to triptans. Studies could also explore the impact of patient demographics and migraine characteristics on satisfaction levels to tailor treatment approaches more effectively. Clinicians may find the results of this study valuable when discussing treatment options and outcomes with patients, potentially leading to greater patient satisfaction and treatment adherence, and ultimately enhancing clinical outcomes and patient quality of life.

References: (1) Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.

(2) Ezzati A, Fanning K, Urani A, Cadiou F, Lipton RB. A comparison of Headache Assessment via Digital Platform in the United States (HeAD-US) and AMPP studies. 2024; 102 (17 suppl 1)-6686