Efficacy and Safety of Atogepant for Preventing Chronic and Episodic Migraines: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Calcitonin gene-related peptide (CGRP) pathway modulators, such as atogepant, represent a novel therapeutic option for the treatment of migraines. We performed a systematic review and meta-analysis to evaluate the effects of 12-week treatment with atogepant compared with placebo in patients with migraine.

A total of four RCTs and 3,140 patients were included, of whom 2,306 were prescribed atogepant. Compared with placebo, atogepant significantly reduced monthly migraine days (WMD -1.27; 95% CI -1.71,-0.83; p < 0.01), days with acute medication use (WMD -1.49; 95% CI -1.96,-1.02; p < 0.01), and monthly headache days (WMD -1.53; 95% CI -1.90,-1.15; p < 0.01). In the subgroup analysis of those outcomes, overall results were similar between groups. There was a significant increase in nausea (RR 2.23; 95% CI 1.43, 3.48; p < 0.01) and constipation (RR 3.57; 95% CI 1.62, 7.89; p < 0.01) in the atogepant-treated group. There were no significant differences in nasopharyngitis, upper airway infection, urinary tract infection, fatigue, serious adverse events, and discontinuation of treatment due to adverse events.

This meta-analysis of RCTs suggests that atogepant is effective in the reduction of migraine episodes among patients with migraine headaches, albeit with an increase in nausea and constipation relative to placebo.