PO-77 | Real-world evidence of Atogepant efficacy in patients unresponsive to anti-CGRP monoclonals

Background: Migraine is a prevalent and disabling neurological disorder, especially in its chronic and high-frequency episodic forms. Monoclonal antibodies (mAbs) targeting the CGRP pathway have improved outcomes for many patients, yet a subset remains refractory. Atogepant, an oral CGRP receptor antagonist, represents a novel therapeutic option. This study assesses the real-world efficacy of Aquipta in patients with chronic or high-frequency episodic migraine who previously failed anti-CGRP mAb therapy. Methods: We conducted an observational study involving 36 patients, representing approximately 15% of our total population treated with anti-CGRP monoclonal antibodies. Among them, 34 had been treated with Galcanezumab and 2 with Fremanezumab. A total of 18 patients (16 with Galcanezumab and 2 with Fremanezumab) had chronic migraine, while the remaining 18 had high-frequency episodic migraine. All patients received Atogepant 60 mg once daily. Treatment response was evaluated based on self-reported reduction in monthly migraine frequency. Statistical analysis was conducted using the chi-square (χ²) test. Results: Thirty-two patients (89%) reported clinical benefit with Atogepant: 30 of those previously treated with Galcanezumab and both treated with Fremanezumab. Four patients (11%) discontinued Aquipta: three due to lack of efficacy and one due to both lack of efficacy and adverse events (confusion, nausea, vertigo). The chi-square test demonstrated a significant association between Aquipta treatment and migraine frequency reduction (χ² = 22.78, p < 0.0001). Conclusion: In this real-world cohort of patients unresponsive to anti-CGRP monoclonal antibodies, Atogepant showed substantial efficacy, with nearly 90% reporting clinical benefit. These findings support Atogepant as a valuable therapeutic alternative in patients with chronic and high-frequency episodic migraine who have not responded to prior mAb treatments.