Objective:

To compare the efficacy of different Atogepant regimens for migraine prevention using network meta-analysis, focusing on migraine and headache days, acute medication use, and ≥50% response rates.

Background:

Migraine is disabling, and preventive treatments are limited. Atogepant shows promise, but comparative evidence across doses is lacking.

Design/Methods:

We searched PubMed, EMBASE, Scopus, and Web of Science through September 2025 for RCTs on Atogepant in migraine prevention. A frequentist network meta-analysis (netmeta, R) using a random-effects model compared dosing regimens across migraine days, headache days, acute medication use, and ≥50% responders, reporting MDs or ORs with 95% CIs and assessing heterogeneity and consistency (τ², I², Q). Language refinement was assisted by ChatGPT (OpenAI, GPT-5)

Results:

Across six RCTs including 4,325 participants, all Atogepant regimens significantly reduced migraine and headache days versus placebo. For migraine days, MDs were –1.84 (95% CI –2.55 to –1.14) for 30 mg BD, –1.57 (95% CI –2.39 to –0.74) for 60 mg BD, –1.46 (95% CI –1.93 to –0.99) for 60 mg OD, –1.30 (95% CI –1.84 to –0.75) for 30 mg OD, and –1.26 (95% CI –1.84 to –0.68) for 10 mg OD. Corresponding reductions in headache days were –1.75 (95% CI –2.38 to –1.12), –1.67 (95% CI –2.53 to –0.82), –1.62 (95% CI –2.01 to –1.23), –1.52 (95% CI –1.96 to –1.08), and –1.45 (95% CI –1.92 to –0.99). Acute medication use declined (MD ≈ –1.4 to –1.8), and the odds of achieving ≥50% migraine reduction were higher for all regimens (OR 2.36–2.72 vs placebo). P-scores and SUCRA ranked 30 mg BD and 60 mg BD as most efficacious. Heterogeneity was modest (I² = 35%), and findings were robust in sensitivity analyses.

Conclusions:

All Atogepant regimens effectively reduced migraine and headache days and decreased acute medication use, with 30 mg BD and 60 mg BD showing the greatest benefit.