Atogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of response
Por:
Muñoz-Vendrell, A, Campoy-Díaz, S, Valín-Villanueva, P, Casas-Limón, J, Fernández-Lázaro, I, González-García, N, Santos-Lasaosa, S, Osorio, YG, Gonzalez-Martinez, A, Campdelacreu, J, Portocarrero-Sánchez, L, Sánchez, LMC, Sánchez, SMG, Pérez-de-la-parte, A, Sánchez-Mateos, NM, López-Bravo, A, Mínguez-Olaondo, A, Sánchez-Soblechero, A, Ros, AL, Hernández, CM, López, AA, Layos-Romero, A, Caronna, E, Torres-Ferrús, M, Alpuente, A, Pozo-Rosich, P, Belvís, R, Garcia-Azorin, D, Díaz-de-Terán, J, Guerrero-Peral, AL, Gago-Veiga, AB, Huerta-Villanueva, M
Publicada:
28 nov 2025
Resumen:
Background Atogepant is approved for migraine prevention and has shown strong efficacy in clinical trials. However, its effectiveness following failure of anti-CGRP monoclonal antibodies (MAbs) has not been evaluated in large real-world populations. Methods This multicenter observational study conducted across Spanish headache units included adults with migraine who initiated atogepant after failure of >= 1 anti-CGRP MAb and had >= 3 months of follow-up. Baseline demographic and clinical variables were collected prospectively, with follow-up assessments at months 3 and 6. The primary outcome was the proportion of patients achieving a >= 50% reduction in monthly migraine days (MMD) at three months. Secondary outcomes included >= 30%, >= 75%, and 100% response rates; changes in headache days, pain intensity, acute medication use, and patient-reported outcomes; adverse events; treatment persistence; and factors associated with response. Results A total of 252 patients were included (mean age 48.9 +/- 12 years; 83.3% female; 80.6% with chronic migraine; 45.6% with continuous daily headache). Prior to atogepant, 39.7% had failed one anti-CGRP MAb, 27.0% two, 20.2% three, and 13.1% four. Median baseline MMD was 16, monthly headache days 27, and acute medication days 20. At 3 months, 44.4% achieved a >= 30% reduction in MMD, 29.7% >= 50%, and 11.7% >= 75%. Adverse events were reported in 52.5% of patients, most commonly constipation (30%) and nausea (25%). At three months, 26.2% had discontinued treatment (65.1% due to inefficacy, 28.8% due to intolerance). Treatment persistence at 180 days was 61% (95% CI 54 to 69%). A higher number of previously failed MAbs was independently associated with reduced odds of >= 50% response (RR 0.79, 95% CI 0.64 to 0.97). Moreover, a higher number of previously failed MAbs was associated with diminished improvements across multiple clinical endpoints, including headache frequency, intensity, acute medication use, and disability measures. Conclusion Atogepant may represent a viable treatment option for patients with migraine who have failed anti-CGRP MAbs. In this large real-world cohort, approximately one-third of patients achieved a >= 50% response, despite a treatment-refractory profile. However, the likelihood of response decreases with a higher number of previously failed MAbs, and mild adverse events are frequent.
Filiaciones:
Muñoz-Vendrell, A:
Univ Barcelona, Hosp Univ Bellvitge IDIBELL, Neurol Dept, Headache Unit, Lhospitalet De Llobregat, Barcelona, Spain
Campoy-Díaz, S:
Univ Barcelona, Hosp Univ Bellvitge IDIBELL, Neurol Dept, Headache Unit, Lhospitalet De Llobregat, Barcelona, Spain
Hosp Viladecans IDIBELL, Neurol Dept, Viladecans, Barcelona, Spain
Valín-Villanueva, P:
Univ Barcelona, Hosp Univ Bellvitge IDIBELL, Neurol Dept, Headache Unit, Lhospitalet De Llobregat, Barcelona, Spain
Casas-Limón, J:
Hosp Univ Fdn Alcorcon, Neurol Dept, Headache Unit, Madrid, Spain
Fernández-Lázaro, I:
Hosp Univ la Princesa, Neurol Dept, Headache Unit, Inst Invest Sanitaria, Madrid, Spain
González-García, N:
Hosp Univ San Carlos, Neurol Dept, Headache Unit, Madrid, Spain
Santos-Lasaosa, S:
Univ Zaragoza, IIS Aragon, Zaragoza, Spain
HCU Lozano Blesa Zaragoza, Neurologia, Zaragoza, Spain
Osorio, YG:
Hosp Clin Univ, Valladolid Biosanitary Res Inst IBIoVALL, Neurol Dept, Headache Unit, Valladolid, Spain
Gonzalez-Martinez, A:
Hosp Clin Univ, Valladolid Biosanitary Res Inst IBIoVALL, Neurol Dept, Headache Unit, Valladolid, Spain
Hosp Univ la Princesa, Serv Neurol & Inmunol, Madrid, Spain
Inst Invest Sanitaria Princesa IIS Princesa, Madrid, Spain
Campdelacreu, J:
Univ Barcelona, Hosp Univ Bellvitge IDIBELL, Neurol Dept, Headache Unit, Lhospitalet De Llobregat, Barcelona, Spain
Portocarrero-Sánchez, L:
Univ Autonoma Madrid, La Paz Univ Hosp, Neurol Dept, Headache Unit, Madrid, Spain
Univ Autonoma Madrid, La Paz Univ Hosp, Inst Hlth Res IdiPAZ, Madrid, Spain
Sánchez, LMC:
Hosp St Joan Despi, Neurol Dept, Consorci Sanitari Integral, Barcelona, Spain
Sánchez, SMG:
Hosp St Joan Despi, Neurol Dept, Consorci Sanitari Integral, Barcelona, Spain
Pérez-de-la-parte, A:
Hosp Univ Rio Hortega Valladolid, Dept Neurol, Headache Unit, Valladolid, Spain
Sánchez-Mateos, NM:
Hosp Santa Creu & Sant Pau, Headache & Neuralgia Unit, Barcelona, Spain
López-Bravo, A:
Hosp Reina Sofia, Neurol Dept, Tudela, Navarra, Spain
Aragon Inst Hlth Res IIS Aragon, Zaragoza, Spain
Univ Publ Navarra, Dept Hlth Sci, Tudela, Spain
Mínguez-Olaondo, A:
Hosp Univ Donostia, Neurol Dept, Donostia San Sebastian, Spain
Inst Salud Biogipuzkoa, Area Neurociencias, Donostia San Sebastian, Spain
Univ Deusto, Fac Ciencias Salud, Donostia Bilbo, Spain
Sánchez-Soblechero, A:
Hosp Gen Univ Gregorio Maranon, Neurol Dept, Headache Unit, Madrid, Spain
Ros, AL:
Hosp Gen Univ Gregorio Maranon, Neurol Dept, Headache Unit, Madrid, Spain
Hernández, CM:
Hosp Univ Canarias, Neurol Dept, Santa Cruz De Tenerife, Spain
López, AA:
Hosp Gen Univ Albacete, Neurol Dept, Headache Unit, Albacete, Spain
Layos-Romero, A:
Hosp Gen Univ Albacete, Neurol Dept, Headache Unit, Albacete, Spain
Caronna, E:
Vall dHebron Hosp, Neurol Dept, Headache Clin, Barcelona, Spain
Univ Autonoma Barcelona, VHIR, Dept Med, Headache & Neurol Pain Res Grp, Barcelona, Spain
Torres-Ferrús, M:
Vall dHebron Hosp, Neurol Dept, Headache Clin, Barcelona, Spain
Univ Autonoma Barcelona, VHIR, Dept Med, Headache & Neurol Pain Res Grp, Barcelona, Spain
Alpuente, A:
Vall dHebron Hosp, Neurol Dept, Headache Clin, Barcelona, Spain
Univ Autonoma Barcelona, VHIR, Dept Med, Headache & Neurol Pain Res Grp, Barcelona, Spain
Pozo-Rosich, P:
Vall dHebron Hosp, Neurol Dept, Headache Clin, Barcelona, Spain
Univ Autonoma Barcelona, VHIR, Dept Med, Headache & Neurol Pain Res Grp, Barcelona, Spain
Belvís, R:
Hosp Santa Creu & Sant Pau, Headache & Neuralgia Unit, Barcelona, Spain
Garcia-Azorin, D:
Hosp Univ Rio Hortega Valladolid, Dept Neurol, Headache Unit, Valladolid, Spain
Díaz-de-Terán, J:
Univ Autonoma Madrid, La Paz Univ Hosp, Neurol Dept, Headache Unit, Madrid, Spain
Univ Autonoma Madrid, La Paz Univ Hosp, Inst Hlth Res IdiPAZ, Madrid, Spain
Guerrero-Peral, AL:
Hosp Clin Univ, Valladolid Biosanitary Res Inst IBIoVALL, Neurol Dept, Headache Unit, Valladolid, Spain
Univ Valladolid UVA, Dept Med, Valladolid, Spain
Gago-Veiga, AB:
Hosp Univ la Princesa, Neurol Dept, Headache Unit, Inst Invest Sanitaria, Madrid, Spain
Huerta-Villanueva, M:
Univ Barcelona, Hosp Univ Bellvitge IDIBELL, Neurol Dept, Headache Unit, Lhospitalet De Llobregat, Barcelona, Spain
Hosp Viladecans IDIBELL, Neurol Dept, Viladecans, Barcelona, Spain
Green Submitted, Green Published, gold
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