Predict the Response to Acute Treatment of Migraine With Rimegepant 75 mg

NCT ID: NCT05888766

Last Updated: 2023-06-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

20 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-07-01

Study Completion Date

2024-09-30

Brief Summary

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Tools to predict which patients could better respond to abortive CGRP target therapy are still lacking. We propose to investigate if biochemical (salivary CGRP) and neurophysiological (evoked potentials) biomarkers can recognize patients with the best chances of responding to Rimegepant 75 mg as an acute treatment of migraine.

Detailed Description

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Background: The understanding of the central role of CGRP in migraine pathophysiology led to the development of new target therapies against this molecule pathway, including Rimegepant. Despite the central role of the CGRP pathway in migraine, it was recently discovered that some migraine attacks are non CGRP-dependent. Tools to predict which patients could better respond to abortive CGRP target therapy are still lacking.

Objective: We propose to investigate if biochemical (salivary CGRP) and neurophysiological (evoked potentials) biomarkers can recognize patients with the best chances of responding to Rimegepant 75 mg as an acute treatment of migraine.

Design of the study and methods: This will be a prospective observational study. The study will be subdivided into four phases: screening visit (T0), salivary collection, observational phase, follow-up visit (T1). At the screening visit (T0) patients with episodic migraine (20 patients), which will be prescribed Rimegepant 75 mg as abortive treatment, will be asked to participate in the study. During the salivary collection phase, patients will be instructed to collect daily saliva samples for a minimum of 7 days and a maximum of 14 days to include a minimum of 1 migraine attack. During the observational phase (1-month duration) patients will take Rimegepant 75 mg for abortive treatment of migraine attacks and, they will be instructed to take extra saliva samples (headache onset, after 2h and 8h) at each migraine attack. Neurophysiological procedures (somatosensory evoked potentials and nociceptive blink reflex) will be recorded at baseline (T0) and after 1 month (follow-up visit, T1) of administration of Rimegepant 75 mg as an abortive migraine treatment. We chose somatosensory evoked potentials (SSEPs) to assess the integrity of the non-pain-related somatosensory lemniscal system and to study habituation phenomena, and nociceptive blink reflex (nBR) to investigate the activity of the caudal trigeminal nucleus. CGRP salivary levels will be quantified with ELISA kit.

Specific aim: We aim to predict Rimegepant (used as abortive therapy) response from baseline CGRP salivary levels and neurophysiological parameters (habituation and sensitization from somatosensory evoked potentials and nociceptive blink reflex). Mixing and comparing these two approaches could help to find a combination of biomarkers able to predict the treatment success. We hypothesize that patients with marked habituation deficit, less sensitization, and more elevated CGRP salivary levels during the attack will be the patients who will respond the most to Rimegepant 75 mg as abortive migraine therapy.

Conditions

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Migraine Disorders

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Episodic migraine patients

20 patients with episodic migraine (\<15 attacks/month) will be recruited from a specialized headache Clinic (headache clinic of the Sapienza University of Rome, Latina).

Rimegepant 75 milligrams

Intervention Type DRUG

At the screening visit patients with episodic migraine, which will be prescribed Rimegepant 75 mg as abortive treatment, will be asked to participate in the study.

Interventions

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Rimegepant 75 milligrams

At the screening visit patients with episodic migraine, which will be prescribed Rimegepant 75 mg as abortive treatment, will be asked to participate in the study.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Clinical diagnosis of Episodic migraine
* Prescription of Rimegepant 75 mg as abortive treatment for migraine
* headache occurring on \< 15 days/four weeks;
* No other primary/secondary headache disorder;
* No contraindication for Rimegepant 75 mg;
* No previous exposure to any anti-CGRP drugs;
* No prophylactic migraine treatment ongoing or in the past 3 months before participation in the study

Exclusion Criteria

* headache occurring \>15 days/four weeks
* Contraindication for Rimegepant 75 mg
* Previous exposure to anti-CGRP drugs;
* Prophylactic migraine treatment ongoing or in the past 3 months before participation in the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Roma La Sapienza

OTHER

Sponsor Role lead

Responsible Party

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Gabriele Sebastianelli

Dr.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Gabriele Sebastianelli, MD

Role: PRINCIPAL_INVESTIGATOR

University of Roma La Sapienza

Locations

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Sapienza University of Rome Polo Pontino - ICOT

Latina, Italy / Latina, Italy

Site Status

Countries

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Italy

Central Contacts

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Gabriele Sebastianelli, MD

Role: CONTACT

+39 3926337082

Facility Contacts

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Gabriele Sebastianelli, MD

Role: primary

References

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Croop R, Goadsby PJ, Stock DA, Conway CM, Forshaw M, Stock EG, Coric V, Lipton RB. Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. Lancet. 2019 Aug 31;394(10200):737-745. doi: 10.1016/S0140-6736(19)31606-X. Epub 2019 Jul 13.

Reference Type RESULT
PMID: 31311674 (View on PubMed)

Lipton RB, Croop R, Stock EG, Stock DA, Morris BA, Frost M, Dubowchik GM, Conway CM, Coric V, Goadsby PJ. Rimegepant, an Oral Calcitonin Gene-Related Peptide Receptor Antagonist, for Migraine. N Engl J Med. 2019 Jul 11;381(2):142-149. doi: 10.1056/NEJMoa1811090.

Reference Type RESULT
PMID: 31291516 (View on PubMed)

Alpuente A, Gallardo VJ, Asskour L, Caronna E, Torres-Ferrus M, Pozo-Rosich P. Salivary CGRP can monitor the different migraine phases: CGRP (in)dependent attacks. Cephalalgia. 2022 Mar;42(3):186-196. doi: 10.1177/03331024211040467. Epub 2021 Oct 4.

Reference Type RESULT
PMID: 34601944 (View on PubMed)

Ashina M, Terwindt GM, Al-Karagholi MA, de Boer I, Lee MJ, Hay DL, Schulte LH, Hadjikhani N, Sinclair AJ, Ashina H, Schwedt TJ, Goadsby PJ. Migraine: disease characterisation, biomarkers, and precision medicine. Lancet. 2021 Apr 17;397(10283):1496-1504. doi: 10.1016/S0140-6736(20)32162-0. Epub 2021 Mar 25.

Reference Type RESULT
PMID: 33773610 (View on PubMed)

Alpuente A, Gallardo VJ, Asskour L, Caronna E, Torres-Ferrus M, Pozo-Rosich P. Salivary CGRP and Erenumab Treatment Response: Towards Precision Medicine in Migraine. Ann Neurol. 2022 Nov;92(5):846-859. doi: 10.1002/ana.26472. Epub 2022 Aug 24.

Reference Type RESULT
PMID: 36054144 (View on PubMed)

Messlinger K, Vogler B, Kuhn A, Sertel-Nakajima J, Frank F, Broessner G. CGRP measurements in human plasma - a methodological study. Cephalalgia. 2021 Nov;41(13):1359-1373. doi: 10.1177/03331024211024161. Epub 2021 Jul 16.

Reference Type RESULT
PMID: 34266288 (View on PubMed)

Casillo F, Sebastianelli G, Di Renzo A, Cioffi E, Parisi V, Di Lorenzo C, Serrao M, Coppola G. The monoclonal CGRP-receptor blocking antibody erenumab has different effects on brainstem and cortical sensory-evoked responses. Cephalalgia. 2022 Oct;42(11-12):1236-1245. doi: 10.1177/03331024221103811. Epub 2022 May 30.

Reference Type RESULT
PMID: 35637558 (View on PubMed)

Sebastianelli G, Casillo F, Di Renzo A, Abagnale C, Cioffi E, Parisi V, Di Lorenzo C, Serrao M, Pierelli F, Schoenen J, Coppola G. Effects of Botulinum Toxin Type A on the Nociceptive and Lemniscal Somatosensory Systems in Chronic Migraine: An Electrophysiological Study. Toxins (Basel). 2023 Jan 14;15(1):76. doi: 10.3390/toxins15010076.

Reference Type RESULT
PMID: 36668895 (View on PubMed)

Coppola G, Di Lorenzo C, Schoenen J, Pierelli F. Habituation and sensitization in primary headaches. J Headache Pain. 2013 Jul 30;14(1):65. doi: 10.1186/1129-2377-14-65.

Reference Type RESULT
PMID: 23899115 (View on PubMed)

Other Identifiers

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S-LT-000002620231

Identifier Type: -

Identifier Source: org_study_id

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