New gepants against acute migraine: A systematic review and network meta-analysis

Abstract

Objectives: Recently two calcitonin gene-related peptide receptor antagonists (ubrogepant and rimegepant) were approved for the acute attack of migraine. This systematic review and network meta-analysis was performed, so as to evaluate and comprehend the effectiveness of both ubrogepant and rimegepant in alleviating the acute attack of migraine. Materials and Methods: An in-depth search was performed through Cochrane library, Pub Med, and clincialtrials.gov, for the period 2015–2019, using the key words: ubrogepant; rimegepant; and acute migraine. The randomized double-blind phase III clinical trials that explored the efficacy of these drugs were considered for inclusion in this review. The outcomes for this review were considered as the proportion of patients who had to resort to rescue medication within 24 h of taking either of the gepant, and the proportion of patients who had achieved sustained pain freedom and relief. In addition, an indirect meta-analysis was also conducted to establish the comparative effectiveness of these drugs. In addition, risk of bias and heterogeneity among the trials were also assessed to ascertain the strength of the trials. Results: A total of five placebo-controlled RCTs were included in this review. Altogether, both drugs demonstrated well in the parameters assessed. Rimegepant was better than ubrogepant, as a lesser proportion of patients used rescue medication by 3.4%, and a significantly higher number of patients achieved sustained pain freedom by 2.1% at 2–24 h. In sustained pain relief at 2–24 h, rimegepant was slightly better than ubrogepant by 0.5%. Hence, rimegepant 75 mg emerged to be better in all outcomes. Conclusions: Both gepants proved to be efficacious in alleviating the acute attack of migraine. Rimegepant displayed superiority over the ubrgepant.