Atogepant reduces triptan use: a pharmacoeconomic analysis in migraine prevention
Background Migraine is a leading cause of disability worldwide, impairing quality of life and productivity. Preventive
therapies aim to reduce attack frequency, severity and the need for acute medications. Oral atogepant (60 mg), a
calcitonin gene-related peptide (CGRP) receptor antagonist, has recently expanded migraine prevention options. This
study evaluated changes in triptan use after atogepant initiation using real-world data.
Methods This retrospective observational study used administrative healthcare databases from the Local Health Unit
of Modena (Italy). Adults with chronic or high-frequency episodic migraine initiating atogepant between November
2023 and December 2024 were identified. Triptan use and related costs were assessed in the 6 months before and
after treatment initiation (index date), measured as dispensed dosage units.
Results Among 95 patients (86% female; mean age 53.5 years), 55 triptan users were included in the analysis. Triptan
use decreased in 45 patients (82%), with ≥ 60% reduction in 27 (49%) and complete discontinuation in 10. Median
consumption decreased from 76 to 24 dosage units, and mean consumption from 88.1 to 45.2. This reduction was
statistically significant (Wilcoxon signed-rank test, p < 0.001). This reduction corresponded to a decrease of €2,591 in
triptan-related pharmaceutical expenditure within the study cohort.
Conclusion Atogepant preventive treatment may substantially reduce acute migraine medication use in real-world
practice, with potential clinical and economic benefits.
Keywords CGRP, Gepants, Headache, Medication-overuse headache, Pain