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Nurtec ODT

CGRP Medications: Better for Men, or Women?

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CGRP related medications for migraine are helping a lot of people. But if you’re going to try one, which medication should you start with? Does your sex make a difference?

Gepant drugs - a difference between women and men?

This is a question that is rarely asked or studied. That’s why a study review published in the medical journal Cephalalgia this year caught my attention. It was one of many studies on CGRP-related drugs – but in this case it was looking at the difference between men and women.

And in the case of one type of drugs, there was a difference – the “gepants” – that is, CGRP receptor inhibitors/antagonists. The specific drugs we’re talking about are:

  • ubrogepant (Ubrelvy)
  • rimegepant (Nurtec ODT)
  • zavegepant (Zavzpret)

Now, when these medications are used for acute migraine treatment – that is, when they’re taken to stop a migraine attack in progress – the evidence is positive. For women. However, for men, there is not yet enough evidence to show a clear benefit.

That doesn’t mean they won’t work for you – and maybe future studies will show a clearer benefit. But it could be that some of the CGRP medications simply work better in women.

It would be helpful to have further studies here, because if this difference stands up in further trials, it would be an easy way to pop certain types of medication higher on the list, because they’ll have a better chance of success, for you.

What about other CGRP medications? The meds for chronic migraine known as CGRP antibodies (the ones that end in “umab” – like fremanezumab or erenumab) seemed to work well for both sexes. Preventative CGRP medications also seemed to help both men and women, but the authors of the study would like to keep an eye out for differences in future studies.

Again, at this point this information shouldn’t stop you from trying CGRP medications. It may be information that can be added to the other info your doctor has in order to decide which to try first.

That being said, we look forward to future studies. Anytime we can make the path shorter to something that works to fight your migraine, we’re very interested.

It will also be very helpful in the future to find out why this is, so that we can better target migraine attacks.

To check out the study for yourself, click on Evaluation of outcomes of calcitonin gene-related peptide (CGRP)-targeting therapies for acute and preventive migraine treatment based on patient sex (pdf).

Big News for Nurtec ODT (Rimegepant)

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Last month it was announced that the migraine medication Nurtec ODT was approved for the preventative treatment of episodic migraine in adults. This is big news – but you need to understand a little bit of background.

Nurtec ODT - preventative and abortive

Nurtec ODT, or rimegepant, is one of the new medications that targets CGRP. There are a number of different treatments that are emerging related to CGRP (calcitonin gene-related peptide). And researchers have been investigating which treatments might be better for prevention, and which may be better to take to stop a migraine attack as it happens.

Rimegepant is in the “gepant” class (hence the last part of its name), a CGRP receptor antagonist. It has been noted for a while that the gepant drugs tend to work very quickly – excellent as an abortive drug to take during a migraine attack. And when Nurtec ODT hit the market, one of its selling-points was that it came as a a fast-acting orally disintegrating tablet – ODT.

But while these drugs have been shuffled down into either the “preventative” or “abortive” category, the question has remained – is it possible that some may be effective as both? In the case of rimegepant, researchers noticed that it tended to have a more sustained effect than some other CGRP related medications. So it seemed like a good candidate for a preventative.

And it seems that this is the case. This from the Biohaven Pharmaceuticals press release:

This new approval makes NURTEC ODT the first oral CGRP antagonist approved for the preventive treatment of migraine, and the only migraine medication approved as a dual therapy for both the acute and preventive treatment. NURTEC ODT is approved for acute treatment in all eligible adult patients with migraine, regardless of the number of monthly migraine days. 

FDA Approves Biohaven’s NURTEC® ODT (rimegepant) for Prevention

For abortive use, the medication is taken as a 75mg dose. Because of the sustained effect, only one tablet is taken within 24 hours.

For preventative use, it’s the same – 75mg, once every other day.

Not only does Nurtec ODT have a good safety record, it will be very attractive for patients who are looking for a preventative, especially if they don’t like to take a number of pills every day. Of course, you do have to find a way to remember to take it every other day – but migraine patients do learn to be organized!

So this is big news. We’ll see if other CGRP related medications also cross the line from one type of medication to another. Meanwhile, many migraine patients who are experiencing a lot of migraine symptoms in a given month will be looking to see if Nurtec ODT is right for them.

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