Another "-gepant"—ubrogepant —is somewhat effective for acute migraine (NNT = 13)

Reference

Lipton RB, Dodick DW, Ailani J, et al. Effect of ubrogepant vs placebo on pain and the most bothersome associated symptom in the acute treatment of migraine. The ACHIEVE II randomized clinical trial. JAMA 2019;322(19):1887-1898.

Synopsis

Ubrogepant is another in the new class of "-gepants" for the management of acute migraine pain. The design of this study and the design of a recent study on rimegepant (see link above) are remarkably alike. For both studies, the trial design and conduct, data collection, management, analysis, medical writing, and editorial support were all provided by the manufacturer. In this study, 1686 adults with the onset of migraine before age 50, at least a one-year history of migraine, and 2 to 8 moderate or severe migraines per month randomly received (concealed allocation assignment) 1 of 2 dosages of ubrogepant (25 mg or 50 mg) or matching placebo. The mean age of participants was 41.5 years, 90% were women, and 82% were white. Complete follow-up occurred for 85% of participants. Using intention-to-treat analysis, the primary outcome—freedom from pain at 2 hours—occurred significantly more often in the treatment group than in the placebo group (21.8% in the 50-mg group, 20.7% in the 25-mg group, and 14.3% in the placebo group; number needed to treat [NNT] = 13.3; 95% CI 8.0 - 39.3). A secondary outcome of freedom from the most bothersome symptom (most commonly photophobia) occurred significantly more often in the 50-mg ubrogepant group compared with placebo (38.9% vs 27.4%; NNT = 8.7; 5.7 - 18.6). The need for rescue medication was also better with active treatment. Adverse events were uncommon.