000170473 001__ 170473
000170473 005__ 20260422085545.0
000170473 0247_ $$2doi$$a10.1177/03331024261431337
000170473 0248_ $$2sideral$$a148964
000170473 037__ $$aART-2026-148964
000170473 041__ $$aeng
000170473 100__ $$aGago-Veiga, Ana Beatriz
000170473 245__ $$aAtogepant for migraine in real-world clinical practice: Insights from a large multicentre study in a treatment-resistant population (GEMA project)
000170473 260__ $$c2026
000170473 5060_ $$aAccess copy available to the general public$$fUnrestricted
000170473 5203_ $$aAim
Atogepant is a novel oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for migraine prevention. This study primarily evaluated its effectiveness and safety in real-world clinical practice, focusing on patients with treatment-resistant migraine, defined according to the European Headache Federation (EHF) criteria as failure of at least three classes of preventive medications, including onabotulinumtoxinA or anti-CGRP monoclonal antibodies (mAbs).
Methods
This prospective multicentre study was conducted across 15 tertiary Headache Units in Spain. Demographic and clinical data, prior preventives, monthly headache days (MHD), monthly migraine days (MMD), and adverse events (AEs) were systematically collected at baseline, 3 months (primary endpoint), and/or 6 months (secondary endpoint).
Results
AimA total of 513 patients were enrolled (mean age 48 years; 88% women). The 3-month analysis included 455 patients, with median MHD decreasing from 21 (IQR 15-30) to 14 (IQR 6-30) and MMD from 14 (IQR 10-20) to 8 (IQR 3-15) (both p < 0.0001). A ≥ 50% reduction was achieved by 34% (MHD) and 29% (MMD), with ≥75% responses in 16% and 13%. Adverse events were mostly mild, mainly constipation (30%) and nausea (18%), and the 3-month discontinuation rate was 11.8%. Responders had shorter migraine chronicity, less analgesic overuse, and fewer prior preventive failures. Although prior inadequate response to anti-CGRP mAbs reduced the likelihood of improvement, it did not prevent meaningful benefit. At analysis, 151 patients had reached the 6-month visit, showing further improvement (MHD 10 [IQR 5-20]; MMD 6 [IQR 4-12]) and fewer adverse events.
Conclusions
Atogepant showed robust real-world effectiveness and good tolerability in a large, treatment-resistant migraine cohort, with clinically meaningful improvement at 3 months and incremental benefit in the subgroup evaluated at 6 months. Lower migraine chronicity and fewer prior preventive failures were associated with better outcomes, supporting the earlier introduction of anti-CGRP therapies in clinical practice.
000170473 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/i-PFIS-IFI15-00158
000170473 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc$$uhttps://creativecommons.org/licenses/by-nc/4.0/deed.es
000170473 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000170473 700__ $$aLópez-Rodríguez, Ana Belén
000170473 700__ $$aSánchez Jiménez, Marina
000170473 700__ $$aIglesias Rubio, Álvaro
000170473 700__ $$aMontes, Nuria
000170473 700__ $$aCamiña Muñiz, Javier
000170473 700__ $$aDomínguez Gallego, Marta
000170473 700__ $$aCalle de Miguel, Carlos
000170473 700__ $$aLatorre, Germán
000170473 700__ $$aRodríguez-Vico, Jaime
000170473 700__ $$aJaimes, Alex
000170473 700__ $$aGómez García, Andrea
000170473 700__ $$aUrtiaga, Sara
000170473 700__ $$aGonzález Salaices, Marta
000170473 700__ $$aDileone, Michele
000170473 700__ $$aGonzález-García, Nuria
000170473 700__ $$aPorta-Etessam, Jesús
000170473 700__ $$aCuadrado, María-Luz
000170473 700__ $$aHerrero San-Martín, Alejandro
000170473 700__ $$aGuerrero-Peral, Ángel-Luis
000170473 700__ $$aGonzález-Osorio, Yesica
000170473 700__ $$aCasas-Limón, Javier
000170473 700__ $$aSánchez-Soblechero, Antonio
000170473 700__ $$aLozano-Ros, Alberto
000170473 700__ $$aDíaz-De-Terán, Javier
000170473 700__ $$aPortocarrero-Sánchez, Leonardo
000170473 700__ $$aMolina-Martínez, Francisco-José
000170473 700__ $$0(orcid)0000-0001-5139-6031$$aSantos-Lasaosa, Sonia$$uUniversidad de Zaragoza
000170473 700__ $$aMartín-Ávila, Guillermo
000170473 700__ $$aRiva, Elena
000170473 700__ $$aFernández-Lázaro, Iris
000170473 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000170473 773__ $$g46, 4 (2026), 1-15$$pCephalalgia$$tCEPHALALGIA$$x0333-1024
000170473 8564_ $$s2534898$$uhttps://zaguan.unizar.es/record/170473/files/texto_completo.pdf$$yVersión publicada
000170473 8564_ $$s2483734$$uhttps://zaguan.unizar.es/record/170473/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000170473 909CO $$ooai:zaguan.unizar.es:170473$$particulos$$pdriver
000170473 951__ $$a2026-04-22-08:33:09
000170473 980__ $$aARTICLE