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

Migraine Disorders Clinical Trial

Official title:

How to Predict Response to Acute Treatment of Migraine With Rimegepant 75 mg: a Biochemical and Neurophysiological Study.

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05888766
• Other study ID #: S-LT-000002620231
• Status: Not yet recruiting
• Start date: July 1, 2023
• Est. completion date: September 30, 2024

Study information

• Verified date: May 2023
• Source: University of Roma La Sapienza
• Contact: Gabriele Sebastianelli, MD
• Phone: +39 3926337082
• Email: gabriele.sebastianelli[@]uniroma1.it
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 20
• Est. completion date: September 30, 2024
• Est. primary completion date: July 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

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

Related Conditions & MeSH terms

• Migraine Disorders

Intervention

Drug:
• 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.

Locations

Country	Name	City	State
Italy	Sapienza University of Rome Polo Pontino - ICOT	Latina	Italy / Latina

Sponsors (1)

Lead Sponsor	Collaborator
University of Roma La Sapienza

Country where clinical trial is conducted

Italy, 

References & Publications (9)

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. — View Citation

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. — View Citation

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. d — View Citation

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 — View Citation

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. — View Citation

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 t — View Citation

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/NEJMoa1 — View Citation

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. — View Citation

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 Electrophys — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Salivary CGRP levels during attacks	In order to identify a biomarker that predicts the Rimegepant's response	from enrollment to one month after the start of therapy
Primary	Relationship between Rimegepant's response and salivary CGRP levels	Differences between responders and not responders to Rimegepant and salivary CGRP levels (pg/ml).	from enrollment to one month after the start of therapy
Primary	Relationship between Rimegepant's response and habituation at baseline	Differences between responders and not responders to Rimegepant and habituation (microvolt) at baseline.	from enrollment to one month after the start of therapy
Primary	Relationship between Rimegepant's response and sensitization at baseline	Differences between responders and not responders to Rimegepant and sensitization (microvolt) at baseline.	from enrollment to one month after the start of therapy
Secondary	Effects of Rimegepant 75 mg on habituation after 1 month of therapy	Comparison between habituation (microvolt) at baseline and habituation (microvolt) after one month of abortive therapy with Rimegepant 75 mg	one month after the start of therapy
Secondary	Changes from Baseline in the sensitization after 1 month of therapy	Comparison between sensitization (microvolt) at baseline and sensitization (microvolt) after one month of abortive therapy with Rimegepant 75 mg	one month after the start of therapy
Secondary	Changes from Baseline in the pain threshold after 1 month of therapy	Comparison between pain threshold (mA) at baseline and pain threshold (mA) after one month of abortive therapy with Rimegepant 75 mg	one month after the start of therapy
Secondary	Changes from Baseline in the sensory detection threshold after 1 month of therapy	Comparison between sensory detection threshold (mA) at baseline and sensory detection threshold (mA) after one month of abortive therapy with Rimegepant 75 mg	one month after the start of therapy