The following is a summary of “Real-world effectiveness, satisfaction, and optimization of ubrogepant for the acute treatment of migraine in combination with onabotulinumtoxinA: results from the COURAGE Study,” published in the August 2023 issue of Headache and Pain by Adams et al.
People use onabotulinumtoxinA as a preventive measure for migraines and often need treatment for sudden attacks. Researchers performed a retrospective study to evaluate the effectiveness of small-molecule calcitonin gene–related peptide (CGRP) receptor antagonist ubrogepant when given onabotulinumtoxinA.
The COURAGE study included people who had onabotulinumtoxinA, an anti-CGRP monoclonal antibody (mAb), as a preventive treatment for migraine. The Migraine Buddy app was used to find participants and track their responses to treated migraine attacks. They investigated ubrogepant effectiveness, provided meaningful pain relief (MPR), and returned to normal function (RNF) at 2 and 4 h after dose for 30 days, and overall acute treatment optimization was evaluated.
About 122 people who have received ubrogepant and onabotulinumtoxinA were included, and 599 times used ubrogepant to treat migraines. After the first time, around 53.3% of participants achieved MPR after 2 hours and 76.2% after 4 hours of ubrogepant intake. About 25.4% of participants returned to normal function 2 h post-ubrogepant and 45.9% after 4 hours. The MPR and RNF results were similar till ten times the use of ubrogepant. While preparing the satisfaction report after 30 days, it was noted that 69.8% of participants were satisfied with the ubrogepant and onabotulinumtoxinA combination, and 77.6% received acute treatment optimization (defined as mTOQ-4 score ≥ 4).
The study showed that using ubrogepant with onabotulinumtoxinA for migraines led to MPR, RNF, and high satisfaction. While the absence of a control group limits causal conclusions, the findings highlighted the potential of app-based designs for assessing real-world treatment effectiveness and satisfaction.