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Goadsby PJ, Friedman DI, Holle-Lee D, Demarquay G, Ashina S, Sakai F, Neel B, Gandhi P, Dabruzzo B, Smith JH, Liu Y, Trugman JM. Efficacy of Atogepant in Chronic Migraine With and Without Acute Medication Overuse in the Randomized, Double-Blind, Phase 3 PROGRESS Trial. Neurology 2024; 103:e209584. [PMID: 38924724 PMCID: PMC11254449 DOI: 10.1212/wnl.0000000000209584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Atogepant is an oral, calcitonin gene-related peptide receptor antagonist approved for the preventive treatment of migraine. We evaluated the efficacy of atogepant for the preventive treatment of chronic migraine (CM) in participants with and without acute medication overuse. METHODS This subgroup analysis of the phase 3, 12-week, randomized, double-blind, placebo-controlled PROGRESS trial evaluated adults with a ≥1-year history of CM, ≥15 monthly headache days (MHDs), and ≥8 monthly migraine days (MMDs) during the 4-week baseline period. Participants were randomized (1:1:1) to placebo, atogepant 30 mg twice daily (BID), or atogepant 60 mg once daily (QD) for 12 weeks and were analyzed by acute medication overuse status (triptans/ergots for ≥10 days per month, simple analgesics for ≥15 days per month, or combinations of triptans/ergots/simple analgesics for ≥10 days per month). Outcomes included change from baseline in mean MMDs, MHDs, and monthly acute medication use days; ≥50% reduction in mean MMDs across 12 weeks; and patient-reported outcome (PRO) measures. RESULTS Of 755 participants in the modified intent-to-treat population, 500 (66.2%) met baseline acute medication overuse criteria (placebo, n = 169 [68.7%]; atogepant 30 mg BID, n = 161 [63.6%]; atogepant 60 mg QD, n = 170 [66.4%]). The least squares mean difference (LSMD) (95% CI) from placebo in MMDs was -2.7 (-4.0 to -1.4) with atogepant 30 mg BID and -1.9 (-3.2 to -0.6) with atogepant 60 mg QD. Mean MHDs (LSMD [95% CI] -2.8 [-4.0 to -1.5] and -2.1 [-3.3 to -0.8]) and mean acute medication use days (LSMD [95% CI] -2.8 [-4.1 to -1.6] and -2.6 [-3.9 to -1.3]) were reduced and a higher proportion of participants achieved ≥50% reduction in MMDs (odds ratio [95% CI] 2.5 [1.5-4.0] and 2.3 [1.4-3.7]) with atogepant 30 mg BID and atogepant 60 mg QD. There was a 52.1%-61.9% reduction in the proportion of atogepant-treated participants meeting acute medication overuse criteria over 12 weeks. Atogepant improved PRO measures. Similar results were observed in the subgroup without acute medication overuse. DISCUSSION Atogepant was effective in participants with CM, with and without acute medication overuse, as evidenced by reductions in mean MMDs, MHDs, and acute medication use days; reductions in the proportion of participants meeting acute medication overuse criteria; and improvements in PROs. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03855137. Submitted: February 25, 2019; first patient enrolled: March 11, 2019. clinicaltrials.gov/ct2/show/NCT03855137. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that atogepant reduces mean MMDs, MHDs, and monthly acute medication use days in adult patients with or without medication overuse.
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Affiliation(s)
- Peter J Goadsby
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Deborah I Friedman
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Dagny Holle-Lee
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Genevieve Demarquay
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Sait Ashina
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Fumihiko Sakai
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Brian Neel
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Pranav Gandhi
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Brett Dabruzzo
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Jonathan H Smith
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Yingyi Liu
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Joel M Trugman
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
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