The following is a summary of “Real-world effectiveness, satisfaction, and optimization of ubrogepant for the acute treatment of migraine in combination with onabotulinumtoxinA: results from the COURAGE Study,” published in the August 2023 issue of Pain by Adams et al.

OnabotulinumtoxinA users often use breakthrough treatments, but evidence for calcitonin gene–related peptide (CGRP) receptor antagonist ubrogepant in combination is limited.

Researchers started a prospective study to assess the real-world effectiveness of CGRP receptor antagonist ubrogepant for acute treatment of migraine in patients using onabotulinumtoxinA for migraine prevention.

They conducted the COURAGE study, which was a multiple-attack, observational study assessing the real-world effectiveness of ubrogepant (50 or 100 mg) for acute migraine treatment in individuals receiving onabotulinumtoxinA, an anti-CGRP monoclonal antibody (mAb), or a combination of both. This analysis specifically focused on those using onabotulinumtoxinA. Participants meeting the criteria were tracked using the Migraine Buddy app. For each ubrogepant-treated attack, meaningful pain relief (MPR) and return to normal function (RNF) were evaluated at 2 and 4 hours post-dose over 30 days.MPR is the significant relief level often felt before the pain completely fades. After 30 days, participants reported satisfaction on a 7-point scale and evaluated acute treatment optimization with the Migraine Treatment Optimization Questionnaire-4 (mTOQ-4).

The results showed 122 participants who received ubrogepant and onabotulinumtoxinA and reported 599 ubrogepant-treated attacks, 53.3% achieved MPR 2 hours post-dose after the first attack, while 76.2% achieved MPR 4 hours post-dose. Additionally, 25.4% achieved a return to normal function (RNF) 2 hours post-dose, and 45.9% achieved RNF 4 hours post-dose. Similar MPR and RNF outcomes were observed across up to 10 ubrogepant-treated attacks. After 30 days, 69.8% of participants reported satisfaction with combining ubrogepant and onabotulinumtoxinA, and 77.6% achieved acute treatment optimization (defined as an mTOQ-4 score ≥ 4).

They concluded that ubrogepant was effective for acute migraine treatment in onabotulinumtoxinA users, with high satisfaction and acute treatment optimization.

Source: thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01622-0