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The following is a summary of “Real-World evidence of the safety and effectiveness of atogepant added to onabotulinumtoxinA for the preventive treatment of chronic migraine: A retrospective chart review,” published in the September 2024 issue of Pain by Blumenfeld et al.

The combination of atogepant and onabotulinumtoxinA demonstrated the potential for greater effectiveness than either treatment alone for preventing chronic migraine (CM) due to their complementary mechanisms of action.

Researchers conducted a retrospective study to assess the safety, tolerability, and effectiveness of adding atogepant to onabotulinumtoxinA as a combination preventive treatment for CM.

They assessed adults with CM who received ≥ 2 consecutive cycles of onabotulinumtoxinA before ≥ 1 month of onabotulinumtoxinA and atogepant combination treatments, atogepant prescriptions (index date) with 2 subsequent onabotulinumtoxinA treatment visits (~ 3 and ~ 6 months post-index) were also reviewed for changes from baseline in monthly headache days (MHDs), ≥ 50% red

uction in MHDs, discontinuation rates, and adverse events (AEs). 

The results showed 55 charts that met safety analysis criteria; 31 had data on headache days at the index and the first post-index visit and were eligible for effectiveness analysis (mean age 46.7 years, 94.5% female), for those with data available before onabotulinumtoxinA treatment (n=25), the mean MHD was 24.0 days, reduced by 8.15 days after onabotulinumtoxinA treatment. After atogepant was added, MHD was incrementally reduced by 4.53 days and 8.75 days from the index date to the first (N=31) and second (N=23) post-index onabotulinumtoxinA treatment visit, respectively, while a ≥ 50% reduction in MHDs was achieved by 45.2% of patients ~ 3 months post-index. Atogepant and onabotulinumtoxinA were discontinued by 16.1% and 6.5% of patients, respectively. In the safety population, 32.7% of patients experienced ≥ 1 AE with no severity. 

They concluded that adding atogepant to onabotulinumtoxinA as a combination preventive treatment for CM was effective in providing an additional reduction in MHDs over ~3 and ~6 months of combination treatment, with the known safety profiles of onabotulinumtoxinA and atogepant.

Source: link.springer.com/article/10.1007/s40122-024-00649-8