Tolerability, safety, and efficacy of atogepant versus topiramate in adults with migraine (TEMPLE): a randomised, head-to-head, phase 3b trial.

This research compares atogepant and topiramate for preventing migraines. Atogepant, a new oral treatment, is a CGRP receptor antagonist. Topiramate is an older, widely used preventive migraine treatment. However, topiramate often has tolerability issues. The TEMPLE trial included 540 participants across 12 countries. Participants had at least four migraine days monthly before the study. They were assigned to receive either atogepant or topiramate for 24 weeks. Results showed that 12% of atogepant users discontinued due to adverse events. In contrast, 30% of topiramate users discontinued for the same reason. Moreover, 64% of atogepant participants had a 50% reduction in migraine days. In comparison, 39% of topiramate participants experienced similar relief. Atogepant demonstrated better tolerability and efficacy over 24 weeks. This study provides important evidence to help clinicians choose effective migraine treatments for patients. Clinical relevance: This research highlights that atogepant may be a better-tolerated option for migraine prevention than topiramate, improving treatment adherence and outcomes for patients.