Atogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of response

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dc.contributor.authorMuñoz-Vendrell, Albert
dc.contributor.authorCampoy-Díaz,Sergio
dc.contributor.authorValín-Villanueva, Paloma
dc.contributor.authorCasas-Limón, Javier
dc.contributor.authorFernández-Lázaro, Iris
dc.contributor.authorGonzález-García, Nuria
dc.contributor.authorSantos Lasaosa, Sonia
dc.contributor.authorGonzález Osorio, Yésica
dc.contributor.authorGonzalez-Martinez, Alicia
dc.contributor.authorCampdelacreu Fumadó, Jaume
dc.contributor.authorPortocarrero-Sánchez, Leonardo
dc.contributor.authorCano Sánchez, Luis Miguel
dc.contributor.authorGarcía Sánchez, Sonia María
dc.contributor.authorPérez de la parte, Alba
dc.contributor.authorMorollón, Noemí
dc.contributor.authorLópez Bravo, Alba
dc.contributor.authorMínguez Olaondo, Ane
dc.contributor.authorSánchez Soblechero, A.
dc.contributor.authorLozano Ros, A.
dc.contributor.authorMorales Hernández, Cristian
dc.contributor.authorAndrés López, A.
dc.contributor.authorLayos-Romero, A.
dc.contributor.authorCaronna, Edoardo
dc.contributor.authorTorres Ferrús, Marta
dc.contributor.authorAlpuente Ruiz, Alicia
dc.contributor.authorPozo Rosich, Patricia
dc.contributor.authorBelvís, Robert
dc.contributor.authorGarcía Azorín, David
dc.contributor.authorDiaz de Teran, Javier
dc.contributor.authorGuerrero Peral, Angel Luis
dc.contributor.authorGago Veiga, Ana Beatriz
dc.contributor.authorHuerta Villanueva, Mariano
dc.date.accessioned2026-03-03T14:46:04Z
dc.date.available2026-03-03T14:46:04Z
dc.date.issued2026-12-01
dc.date.updated2026-03-03T14:46:04Z
dc.description.abstractBackground: 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 anti-CGRP 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.en
dc.identifier.citationMuñoz-Vendrell, A., Campoy-Díaz, S., Valín-Villanueva, P., Casas-Limón, J., Fernández-Lázaro, I., González-García, N., Santos-Lasaosa, S., González Osorio, Y., Gonzalez-Martinez, A., Campdelacreu, J., Portocarrero-Sánchez, L., Cano Sánchez, L. M., García Sánchez, S. M., Pérez-de-la-parte, A., Morollón Sánchez-Mateos, N., López-Bravo, A., Mínguez-Olaondo, A., Sánchez-Soblechero, A., Lozano Ros, A., et al. (2026). Atogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of response. Journal of Headache and Pain, 27(1). https://doi.org/10.1186/S10194-025-02239-1
dc.identifier.doi10.1186/S10194-025-02239-1
dc.identifier.eissn1129-2377
dc.identifier.issn1129-2369
dc.identifier.urihttps://hdl.handle.net/20.500.14454/5317
dc.language.isoeng
dc.publisherBioMed Central Ltd
dc.rights© The Author(s) 2025
dc.subject.otherAnti-CGRP monoclonal antibodies
dc.subject.otherAtogepant
dc.subject.otherMigraine
dc.subject.otherReal-world
dc.subject.otherTreatment failure
dc.titleAtogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of responseen
dc.typejournal article
dcterms.accessRightsopen access
oaire.citation.issue1
oaire.citation.titleJournal of Headache and Pain
oaire.citation.volume27
oaire.licenseConditionhttps://creativecommons.org/licenses/by/4.0/
oaire.versionVoR
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