Ubrogepant for acute treatment of perimenstrual migraine

Menstruation is a significant risk factor for migraine; over 50% of patients report an association between migraine attacks and monthly menstruation. Perimenstrual migraine can be also difficult to treat. In a randomised, 52-week extension trial, ubrogepant was efficacious in the acute treatment of perimenstrual migraine (pmM), comparable with that observed for non-pmM.

Perimenstrual migraine can be relatively difficult to treat, as attacks are often longer in duration and resistant to treatment. In a phase 3, randomised, open-label, 52-week extension trial, adults with migraine were randomised to ubrogepant 50 mg, ubrogepant 100 mg, or usual care. The intention-to-treat population consisted of 808 ubrogepant users who treated 21,419 migraine attacks with ubrogepant. Of this population, 354 (43.8%) were menstruating women. A post-hoc analysis was presented which included all 278 women (78.5%) who treated at least 1 pmM attack [1]. In total, 8,620 pmM attacks were treated, 40.2% of all treated migraine attacks.

In the ubrogepant 50 mg dose group, significantly more pmM patients (28.7%) achieved pain freedom at 2 hours than non-pmM patients (22.3%; P=0.046). In the 100 mg dose group, these percentages were 29.7% and 24.8%, respectively (P=0.406). In the 50 mg dose group, pain relief at 2 hours was achieved by 64.8% and 64.9%, respectively (P=0.396), and in the 100 mg dose group by 67.1% and 67.8% (P=0.253). Absence of photophobia, phonophobia, and nausea were seen in similar percentages of patients with pmM and non-pmM attacks. Treatment-related adverse events were reported by 18/137 (12.8%) and 12/141 (8.8%) in the ubrogepant 50 mg and 100 mg subgroups.

In conclusion, this post-hoc analysis showed that the overall efficacy of ubrogepant for the treatment of pmM was comparable with that observed for non-pmM.

1. Pavlovic JM, et al. Ubrogepant Was Safe and Well Tolerated in the Acute Treatment of Perimenstrual Migraine. S5.004, AAN 2021 Virtual Congress, 17-22 April.

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