Date of Award

2022

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Is rimegepant an effective treatment for acute migraine pain in adults?”

STUDY DESIGN: A systematic review of three, peer-reviewed randomized placebo-controlled trials (RCT’s).

DATA SOURCES: All studies were obtained from PubMed and were published in English in peer-reviewed journals between 2014-2019. The articles were selected based on their relevance to the clinical question posed in the objective and their inclusion of patient oriented outcomes.

OUTCOMES MEASURED: The main outcome being assessed in all articles was freedom from pain. The absence/presence of pain was self-reported by patients two hours post rimegepant/placebo dose in all trials.

RESULTS: All RCT’s found rimegepant to be superior in eliminating migraine pain compared to the placebo group. Croop et al. (2019) found that 21.2% of patients treated with rimegepant had freedom from pain 2 hours postdose while only 10.9% of patients treated with the placebo achieved freedom of pain 2 hours postdose. The study was statistically significant (p-value < 0.0001) and had a large treatment effect based on a calculated NNT of 10. Lipton et al. (2019) found that 19.6% of patients treated with rimegepant had freedom from pain 2 hours postdose while only 12.0% of patients treated with the placebo achieved freedom from pain 2 hours postdose. The study was statistically significant (p-value < 0.001) and had a large treatment effect based on a calculated NNT of 13. Marcus et al. (2014) found that 31.4% of patients treated with rimegepant had freedom from pain 2 hours postdose while only 15.3% of patients treated with the placebo achieved freedom from pain 2 hours postdose. The study was statistically significant (p-value ≤ 0.002) and had a large treatment effect based on a calculated NNT of 7.

CONCLUSIONS: All three studies found rimegepant to be more effective at eliminating acute migraine pain of moderate to severe intensity compared to the placebo. Statistically significant p-values as well as large treatment effects were found in each study. Future research should be conducted looking at safety among individuals with cardiovascular disease.

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