170473 20260422085545.0 doi 10.1177/03331024261431337 sideral 148964 ART-2026-148964 eng Gago-Veiga, Ana Beatriz Atogepant for migraine in real-world clinical practice: Insights from a large multicentre study in a treatment-resistant population (GEMA project) 2026 Aim 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. Access copy available to the general public Unrestricted info:eu-repo/grantAgreement/ES/ISCIII/i-PFIS-IFI15-00158 info:eu-repo/semantics/openAccess by-nc https://creativecommons.org/licenses/by-nc/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion López-Rodríguez, Ana Belén Sánchez Jiménez, Marina Iglesias Rubio, Álvaro Montes, Nuria Camiña Muñiz, Javier Domínguez Gallego, Marta Calle de Miguel, Carlos Latorre, Germán Rodríguez-Vico, Jaime Jaimes, Alex Gómez García, Andrea Urtiaga, Sara González Salaices, Marta Dileone, Michele González-García, Nuria Porta-Etessam, Jesús Cuadrado, María-Luz Herrero San-Martín, Alejandro Guerrero-Peral, Ángel-Luis González-Osorio, Yesica Casas-Limón, Javier Sánchez-Soblechero, Antonio Lozano-Ros, Alberto Díaz-De-Terán, Javier Portocarrero-Sánchez, Leonardo Molina-Martínez, Francisco-José Santos-Lasaosa, Sonia Universidad de Zaragoza (orcid)0000-0001-5139-6031 Martín-Ávila, Guillermo Riva, Elena Fernández-Lázaro, Iris 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 46, 4 (2026), 1-15 Cephalalgia CEPHALALGIA 0333-1024 2534898 http://zaguan.unizar.es/record/170473/files/texto_completo.pdf Versión publicada 2483734 http://zaguan.unizar.es/record/170473/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:170473 articulos driver 2026-04-22-08:33:09 ARTICLE