A Preliminary Systematic Review and Meta-analysis of Randomized Control Trials of Rimegepant and Zavegepant for Acute Pain Relief from Migraine
Sakina Matcheswalla1, Kuldeep N. Yadav2, Rahul Jena3, Lakshmi Sai Deepak Reddy Velugoti4, Prince Kwabla Perkyi-Boateng5, Aleksei Budnik6, Zabeen Mahuwala7
1Neurology, University of Texas Medical Branch, 2University of Pennsylvania, 3Bharati Vidyapeeth Medical College, 4NRI Academy of Medical Sciences, 5Korle-Bu Teaching Hospital Medical Department, 6East-Kazakhstan Regional Specialized Medical Center, 7University of Kentucky, KY Clinic Neurology Department
Objective:
Our aim was to compare the efficacy of Rimegepant and Zavegepant in relieving pain from migraine in acute settings.
Background:
There is limited research summarizing the efficacy of newer gepants in migraine therapy. Rimegepant and Zavegepant have different administration routes, oral vs intranasal, respectively.
Design/Methods:
We reviewed the randomized clinical trials (RCTs) for Rimegepant and Zavegapant registered between 2017 and 2023 in the database of the NIH’s National Library of Medicine (clinicaltrials.gov). To compare the efficacy of the two medications, we conducted a random-effects meta-analysis of the RCTs for the percentage of pain relief from headache at two hours and 24 hours. Pain relief from headache was measured on a 4-point scale (none, mild, moderate, severe) and recorded as a dichotomized variable. All analyses were performed in R.
Results:
We included three RCTs for Rimegepant and two RCTS for Zavegapant that contained our outcome of interest. All five RCTs were conducted in the United States, were double-blinded with placebo control, and enrolled a majority of females (all RCTs >84%). Overall, the percentages of pain relief from headache at two hours and at 24 hours were 58.5% [95% Confidence Interval (CI): 56.6%-60.3%] and 42.6% [95% CI: 39.9%-45.4%], respectively, for the treatment groups among the five RCTs. For Rimegepant, the percentage of pain relief from headache was 58.0% [95% CI: 56.0%-60.2%] at two hours and 43.2% [95% CI: 39.0%-47.5%] at 24 hours. For Zavegapant, the percentages of pain relief from headache was 59.5% [95% CI: 56.4%-62.5%] at two hours and 41.5% [95% CI: 38.5%-45.5%] at 24 hours.
Conclusions:
Our results suggest that Rimegepant and Zavegepant might be equally efficacious in providing acute pain relief from migraine. However, further review of RCTs and observational studies is warranted to elucidate the efficacy of gepants for acute pain relief from migraine