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

# metadata.dc.description.abstract[].value
Background 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.

# metadata.dc.relation.ispartof[].value
The Journal of Headache and Pain, 2025, vol. 27, num. 2, p. 1-12

# metadata.dc.rights[].value
cc by (c) Muñoz-Vendrell, Albert, et al, 2026

# metadata.dc.source[].value
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

# metadata.dc.title[].value
Atogepant after anti-CGRP monoclonal antibodies failure in migraine: a multicenter real-world study of effectiveness, safety, persistence and predictors of response