Rimegepant
| Evidence Level: L5 | Predicted Indications: 5 |
Table of Contents
Rimegepant: Atrophoderma vermiculata
One-Sentence Summary
Rimegepant is a CGRP receptor antagonist originally used to treat migraine, both acute treatment and prevention of episodic migraine. The TxGNN model predicts it may be useful for atrophoderma vermiculata. There are no registered clinical trials for this specific subtype, but 16 publications on rimegepant in migraine give indirect support.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Atrophoderma vermiculata |
| TxGNN Prediction Score | 0.9976 |
| Evidence Level | L5 (indirect evidence only; no studies in this subtype) |
| Canada Market Status | Marketed (marketed DINs: 1 of 1) |
| Number of DINs | 1 (marketed: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Rimegepant is a small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist. Blocking CGRP signalling is the mechanism behind its approved use in the acute treatment of migraine with or without aura and in preventing episodic migraine. The mechanism of action data compiled for this report is not available, so this description relies on published literature about the drug class.
The supporting evidence is indirect. The publications compiled are general migraine reviews, approval summaries, safety and pharmacokinetic studies, and a meta-analysis. None of them is a study in patients with brainstem aura, so the link is inferred from the parent indication.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 42143245 | 2026 | Systematic review and meta-analysis | J Headache Pain | Efficacy and tolerability of a single 75 mg oral dose of rimegepant versus placebo for acute migraine attacks in adults |
| 36739335 | 2023 | Review | CNS Drugs | Rimegepant approved for acute migraine with or without aura and for prevention of episodic migraine; ODT formulation; more effective than placebo in phase III trials |
| 32270407 | 2020 | Review | Drugs | First approval of rimegepant ODT for acute migraine treatment |
| 41366286 | 2025 | Phase 4 open-label study | J Headache Pain | 24-week safety and tolerability of once-daily 75 mg rimegepant for episodic migraine prevention |
| 41066271 | 2025 | Phase 3 open-label study | Cephalalgia | Long-term safety and effectiveness of rimegepant 75 mg ODT for acute migraine in Chinese adults |
| 38307667 | 2024 | Review | Handb Clin Neurol | Overview of gepants; ubrogepant and rimegepant are approved second-generation agents |
| 32993366 | 2021 | Review | Ann Pharmacother | Efficacy, safety and cost of ubrogepant, lasmiditan and rimegepant for acute migraine |
| 35790906 | 2022 | Network meta-analysis | J Headache Pain | Relative efficacy of lasmiditan versus rimegepant and ubrogepant for acute migraine |
| 41574090 | 2026 | Prospective longitudinal MRA study | Brain Commun | Effects of rimegepant on cerebral and extracerebral arteries during migraine attacks |
| 41652664 | 2026 | Retrospective analysis | Headache | Tolerability and effectiveness of off-label rimegepant for acute migraine in adolescents |
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02543605 | NURTEC ODT | Orally disintegrating tablet (per the product name) | Not listed in the data compiled |
Safety Considerations
Drug Interactions: The interaction screening returned 57 interacting drugs. Examples include:
- Major: dexamethasone, lumacaftor, apalutamide
- Moderate: aprepitant, clarithromycin, rolapitant, sulfasalazine, cobicistat, eltrombopag, ivacaftor, chloramphenicol, erythromycin, fluconazole, ketoconazole, tacrolimus
Many of these are CYP3A4 and transporter-related interactions. Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The predicted indication is a subtype of the disease rimegepant is already approved for, so the mechanism is plausible. However, no trials or publications specifically address brainstem aura, so the evidence is indirect (L4). The model score is high, but it does not replace subtype-specific data.
To proceed, the following is needed:
- Subtype-specific evidence, such as post hoc analyses of existing phase 3 migraine trials in patients with brainstem aura, or a dedicated study
- Confirmation of whether current Canadian labelling for migraine already covers this subtype
- Package insert warnings and contraindications from Health Canada, which are currently missing
- Detailed mechanism of action data from DrugBank
- Review of the major drug interactions, especially with strong CYP3A4 inducers and inhibitors
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.