The role of Atogepant in migraine prevention: a systematic review and meta-analysis.

Background: Atogepant is a CGRP receptor antagonist used in prevention of migraine. This study assesses the safety and efficacy of this drug in management of migraine headaches.

Methods: PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched until March 24, 2025. Outcomes assessed included monthly migraine and headache day change from baseline at 12 weeks, ≥ 50% reduction in monthly migraine days (MMD), acute medication use days at 12 weeks, treatment-emergent adverse events (TEAE), score on Role Function-Restrictive domain of MSQ at 12 weeks, score on daily activity performance and physical impairment domains of AIM-D at 12 weeks. Subgroup analysis was performed based on different doses of atogepant.

Results: Six RCTs comprising of 4052 patients were included. Atogepant showed significant improvement in patients with migraine in terms of MMD over 12 weeks at all doses, 10 mg, 30 mg, and 60 mg. Moreover, it also reduced monthly headache days, had 50% reduction in MMD, and reduced days requiring acute medication use. Atogepant was shown to increase the risk of TEAE, particularly gastrointestinal (GI) side effect including constipation and nausea, however, occurrence of other side effects with atogepant use was insignificant.

Conclusion: Atogepant is a highly effective CGRP antagonist for migraine prevention, however, it is associated with increased incidence of GI side effects. Further studies are needed to comprehensively investigate the relationship between atogepant dosage and migraine improvement and safety profile.