000165945 001__ 165945
000165945 005__ 20260116002211.0
000165945 0247_ $$2doi$$a10.1186/s10194-025-02239-1
000165945 0248_ $$2sideral$$a147440
000165945 037__ $$aART-2025-147440
000165945 041__ $$aeng
000165945 100__ $$aMuñoz-Vendrell, Albert
000165945 245__ $$aAtogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of response
000165945 260__ $$c2025
000165945 5060_ $$aAccess copy available to the general public$$fUnrestricted
000165945 5203_ $$aBackground 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 antiCGRP 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.
000165945 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000165945 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000165945 700__ $$aCampoy-Díaz, Sergio
000165945 700__ $$aValín-Villanueva, Paloma
000165945 700__ $$aCasas-Limón, Javier
000165945 700__ $$aFernández-Lázaro, Iris
000165945 700__ $$aGonzález-García, Nuria
000165945 700__ $$0(orcid)0000-0001-5139-6031$$aSantos-Lasaosa, Sonia$$uUniversidad de Zaragoza
000165945 700__ $$aGonzález Osorio, Yésica
000165945 700__ $$aGonzalez-Martinez, Alicia
000165945 700__ $$aCampdelacreu, Jaume
000165945 700__ $$aPortocarrero-Sánchez, Leonardo
000165945 700__ $$aCano Sánchez, Luis Miguel
000165945 700__ $$aGarcía Sánchez, Sonia María
000165945 700__ $$aPérez-de-la-parte, Alba
000165945 700__ $$aMorollón Sánchez-Mateos, Noemí
000165945 700__ $$aLópez-Bravo, Alba
000165945 700__ $$aMínguez-Olaondo, Ane
000165945 700__ $$aSánchez-Soblechero, Antonio
000165945 700__ $$aLozano Ros, Alberto
000165945 700__ $$aMorales Hernández, Cristian
000165945 700__ $$aAndrés López, Alberto
000165945 700__ $$aLayos-Romero, Almudena
000165945 700__ $$aCaronna, Edoardo
000165945 700__ $$aTorres-Ferrús, Marta
000165945 700__ $$aAlpuente, Alicia
000165945 700__ $$aPozo-Rosich, Patricia
000165945 700__ $$aBelvís, Robert
000165945 700__ $$aGarcia-Azorin, David
000165945 700__ $$aDíaz-de-Terán, Javier
000165945 700__ $$aGuerrero-Peral, Ángel Luis
000165945 700__ $$aGago-Veiga, Ana Beatriz
000165945 700__ $$aHuerta-Villanueva, Mariano
000165945 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000165945 773__ $$g27, 2 (2025), [12 pp.]$$pJ. headache pain$$tThe Journal of headache and pain$$x1129-2369
000165945 8564_ $$s2653977$$uhttps://zaguan.unizar.es/record/165945/files/texto_completo.pdf$$yVersión publicada
000165945 8564_ $$s2127675$$uhttps://zaguan.unizar.es/record/165945/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000165945 909CO $$ooai:zaguan.unizar.es:165945$$particulos$$pdriver
000165945 951__ $$a2026-01-15-21:57:08
000165945 980__ $$aARTICLE