Clinical Effectiveness of Atogepant with Onabotulinum Toxin Type A in Treatment of Chronic Migraine
Antranig Andonian1, Raghav Govindarajan2
1A.T. Still University School of Osteopathic Medicine Arizona, 2HSHS St. Elizabeth Medical Group
Objective:
To describe the clinical effectiveness and side effects of adding atogepant to onabotulinum toxin type A for chronic migraines.
Background:
Clinical evidence supports the use of onabotulinum toxin type A for prevention of chronic migraine (CM). More recently, atogepant an orally active calcitonin gene-related peptide receptor antagonist has been approved for both episodic and CM prophylaxis. Data on combined treatment (onabotulinum toxin type A and atogepant) for CMs, however, are limited.
Design/Methods:
This is a retrospective chart review of eight patients with CM who had received three rounds of botulinum toxin type A (as per PREEMPT protocol) and were on atogepant for at least three months. Monthly migraine days (MMD) pre-onabotulinum toxin type A, three rounds after onabotulinum toxin type A, one month after addition of atogepant and three months after atogepant were collected. A p value of <0.05 was considered statistically significant.
Results:
Eight patients mean age 35.25 years, F:M 7:1, (seven Caucasians, one African American) were included. Average MMD of the cohort before onabotulinum toxin type A was 19.5 days. Average MMD after three rounds of botulinum toxin was 12.5 days. Average MMD after one month of atogepant was 7.38 days. Average MMD after three months of atogepant was 4.38 days (95% CI 6.01 to 9.74, p value< 0.05). Nausea after starting atogepant was reported by one patient, rest of the patients did not report any side effects. Three patients were able to taper down and stop topiramate after adding atogepant. Three patients were on topiramate (average dose 25mg), two of them were gabapentin (average dose 300mg) and one was on nortriptyline (10mg).
Conclusions:
This study provides preliminary evidence on the benefits of add on therapy with atogepant in patients with chronic migraine who are already on onabotulinum toxin type A.