Although oral calcitonin gene-related peptide receptor antagonists such as atogepant are approved for migraine prevention, their tolerability and efficacy have not been directly compared with conventional oral non-specific migraine preventive treatments. To address this, a phase 3b study compared the tolerability, safety, and efficacy of atogepant (n=273) versus topiramate (n=267) in adults with migraine. During the 24-week double-blind period, discontinuation due to treatment-emergent adverse events was lower with atogepant than with topiramate (12% vs 30%).

Similarly, treatment-related adverse events were reported less frequently with atogepant (56%) than with topiramate (78%). Serious treatment-emergent adverse events observed in six participants receiving atogepant and three receiving topiramate, with one serious event (anaphylactic reaction) in the atogepant group considered…