Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial
Abstract Background Migraine is a disabling disorder that impacts 40 million people in the US. Zavegepant is the first calcitonin gene-related peptide (CGRP) receptor antagonist nasal-spray approved for the acute treatment of migraine with or without aura in adults. This study aimed to evaluate the...
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BMC
2025-01-01
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| Series: | The Journal of Headache and Pain |
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| Online Access: | https://doi.org/10.1186/s10194-024-01915-y |
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| author | Lauren Powell Fiona O’Sullivan Pramoda Jayasinghe Basia Rogula Feng Dai Jessica Cirillo Samantha Sweeney Lucy Abraham Jessica Ailani |
| author_facet | Lauren Powell Fiona O’Sullivan Pramoda Jayasinghe Basia Rogula Feng Dai Jessica Cirillo Samantha Sweeney Lucy Abraham Jessica Ailani |
| author_sort | Lauren Powell |
| collection | DOAJ |
| description | Abstract Background Migraine is a disabling disorder that impacts 40 million people in the US. Zavegepant is the first calcitonin gene-related peptide (CGRP) receptor antagonist nasal-spray approved for the acute treatment of migraine with or without aura in adults. This study aimed to evaluate the proportion of patients in various pain and functional disability states over 48-h, for patients treated with zavegepant 10 mg nasal-spray versus placebo. Methods This post-hoc analysis included adult patients with > 1-year history of migraine from BHV3500-301 (NCT04571060): a phase 3 double-blind, randomized, placebo-controlled, single-attack study. Over 48-h, pain severity and functional disability were captured at various timepoints (pre- and post-dosing). The proportion of patients at each pain severity or functional disability state and the time spent in each category was calculated. These were analyzed for patients with complete timepoint data available and using missing not at random (MNAR) imputation for missing timepoints. Predictors of functional disability were assessed using a mixed-effects logistic regression model. Results There were 1,269 patients included in the MNAR imputation analysis, and between 630–641 in the complete-case analysis. As early as 15-min post-dose, a larger proportion of zavegepant patients achieved no/mild pain compared to placebo, despite balanced migraine severity pre-dose. Furthermore, zavegepant patients spent significantly more time (over 2.5-h) in pain freedom compared to placebo. Similarly, a higher proportion of patients with normal function was observed with zavegepant vs placebo, as early as 30-min post-dose. Over 48-h, patients treated with zavegepant spent an average of ~ 3-h longer with normal functioning compared to placebo. Results were similar when analyzing both analytic groups. In a regression model, treatment with zavegepant, lower pain severity, fewer baseline monthly migraine days, and absence of photophobia, phonophobia, and nausea were associated with better functioning (p < 0.05) over 48-h. Conclusion This post-hoc analysis demonstrates the benefit of zavegepant nasal spray over placebo on two patient-centric endpoints: time spent with pain freedom and normal functioning over 48-h post-dose. These data support the use of zavegepant for providing rapid and sustained freedom from migraine pain and freedom from migraine related disability, particularly for those who would benefit from the nasal CGRP formulation. |
| format | Article |
| id | doaj-art-86eb6472485a4513baec55ac0f96205e |
| institution | Kabale University |
| issn | 1129-2377 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | The Journal of Headache and Pain |
| spelling | doaj-art-86eb6472485a4513baec55ac0f96205e2025-01-05T12:41:48ZengBMCThe Journal of Headache and Pain1129-23772025-01-0126111810.1186/s10194-024-01915-yReduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trialLauren Powell0Fiona O’Sullivan1Pramoda Jayasinghe2Basia Rogula3Feng Dai4Jessica Cirillo5Samantha Sweeney6Lucy Abraham7Jessica Ailani8Broadstreet Health Economics & Outcomes ResearchBroadstreet Health Economics & Outcomes ResearchBroadstreet Health Economics & Outcomes ResearchBroadstreet Health Economics & Outcomes ResearchPfizer IncPfizer IncPfizer IncPfizer R&D UK Ltd.Department of Neurology, Medstar Georgetown University HospitalAbstract Background Migraine is a disabling disorder that impacts 40 million people in the US. Zavegepant is the first calcitonin gene-related peptide (CGRP) receptor antagonist nasal-spray approved for the acute treatment of migraine with or without aura in adults. This study aimed to evaluate the proportion of patients in various pain and functional disability states over 48-h, for patients treated with zavegepant 10 mg nasal-spray versus placebo. Methods This post-hoc analysis included adult patients with > 1-year history of migraine from BHV3500-301 (NCT04571060): a phase 3 double-blind, randomized, placebo-controlled, single-attack study. Over 48-h, pain severity and functional disability were captured at various timepoints (pre- and post-dosing). The proportion of patients at each pain severity or functional disability state and the time spent in each category was calculated. These were analyzed for patients with complete timepoint data available and using missing not at random (MNAR) imputation for missing timepoints. Predictors of functional disability were assessed using a mixed-effects logistic regression model. Results There were 1,269 patients included in the MNAR imputation analysis, and between 630–641 in the complete-case analysis. As early as 15-min post-dose, a larger proportion of zavegepant patients achieved no/mild pain compared to placebo, despite balanced migraine severity pre-dose. Furthermore, zavegepant patients spent significantly more time (over 2.5-h) in pain freedom compared to placebo. Similarly, a higher proportion of patients with normal function was observed with zavegepant vs placebo, as early as 30-min post-dose. Over 48-h, patients treated with zavegepant spent an average of ~ 3-h longer with normal functioning compared to placebo. Results were similar when analyzing both analytic groups. In a regression model, treatment with zavegepant, lower pain severity, fewer baseline monthly migraine days, and absence of photophobia, phonophobia, and nausea were associated with better functioning (p < 0.05) over 48-h. Conclusion This post-hoc analysis demonstrates the benefit of zavegepant nasal spray over placebo on two patient-centric endpoints: time spent with pain freedom and normal functioning over 48-h post-dose. These data support the use of zavegepant for providing rapid and sustained freedom from migraine pain and freedom from migraine related disability, particularly for those who would benefit from the nasal CGRP formulation.https://doi.org/10.1186/s10194-024-01915-yMigraineCalcitonin gene-related peptideRandomized controlled trialTherapeuticsPainFunctional disability |
| spellingShingle | Lauren Powell Fiona O’Sullivan Pramoda Jayasinghe Basia Rogula Feng Dai Jessica Cirillo Samantha Sweeney Lucy Abraham Jessica Ailani Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial The Journal of Headache and Pain Migraine Calcitonin gene-related peptide Randomized controlled trial Therapeutics Pain Functional disability |
| title | Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial |
| title_full | Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial |
| title_fullStr | Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial |
| title_full_unstemmed | Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial |
| title_short | Reduction of pain and functional disability over time in patients treated with zavegepant: a post-hoc analysis of the BHV3500-301 phase 3 randomized controlled trial |
| title_sort | reduction of pain and functional disability over time in patients treated with zavegepant a post hoc analysis of the bhv3500 301 phase 3 randomized controlled trial |
| topic | Migraine Calcitonin gene-related peptide Randomized controlled trial Therapeutics Pain Functional disability |
| url | https://doi.org/10.1186/s10194-024-01915-y |
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