A focus on quality of life and a swift return to normal activities for migraine sufferers

   Migraine ranks second among all conditions in terms of its impact on quality of life and work capacity, and is the leading cause of disability among people under the age of 50. Triptans, which have long been the mainstay of acute treatment, have a number of limitations: contraindications in cardiovascular disease, the risk of developing medication overuse headache (MOH) with frequent use, as well as ineffectiveness or intolerance in a significant proportion of patients. The advent of gepants – antagonists of the calcitonin gene-related peptide (CGRP) receptor - has opened up new possibilities for the treatment of migraine. Rimegepant (Nurtec©) is the first representative of this class to be registered in the Russian Federation and the only drug in the world with two indications: acute attack relief and prophylactic treatment of episodic migraine. This review presents current data on the mechanisms of action, efficacy, safety and impact on functional recovery of rimegepant in the acute treatment of migraine. An analysis was conducted of data from clinical trials (randomised controlled trials, open-label long-term trials, and real-world clinical practice studies), systematic reviews and meta-analyses focusing on the use of rimegepant for the relief of migraine attacks. Rimegepant acts via a dual mechanism of antagonism against CGRP receptors and amylin 1 receptors (AMY1), providing effective relief of pain and associated symptoms in a broad population of adult migraine patients. Unlike triptans, the drug does not cause vasoconstriction and has no cardiovascular contraindications. In a 52-week safety study, no cases of MOH were recorded; the frequency of use remained stable with a downward trend. Rimegepant is effective in patients with triptan failure or intolerance (55.9 % vs 32.7 % for placebo; p < 0.0001). The drug provides a rapid onset of action (from 15 minutes), relief of the most debilitating symptom within 2 hours in 40.2 % of patients (compared with 29.2 % in the placebo group; p < 0.0001) and high treatment satisfaction (71.4 % vs 52.0 % for triptans; p < 0.001). According to the WPAI-GH questionnaire, rimegepant significantly reduces presenteeism (by 10.6 %; p = 0.018) and overall work impairment (by 11.3 %; p = 0.021), restoring patients' ability to work. The cardiovascular safety of the drug has been confirmed in a population of patients with cardiovascular risk factors (incidence of serious adverse events 2.4 % in the FRS ≥10 % group vs 2.6 % in the low-risk group). Thus, rimegepant is a highly effective and safe agent for the relief of migraine attacks, offering key advantages over triptans: the absence of vaso-constriction and cardiovascular contraindications, minimal risk of developing MOH, efficacy in patients unresponsive to triptans, rapid restoration of work capacity, and high patient satisfaction. The drug may be considered the treatment of choice in these patient populations.

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