{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:17:24Z","timestamp":1783383444531,"version":"3.54.6"},"reference-count":23,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Atogepant is a novel oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for migraine prevention. This study primarily evaluated its effectiveness and safety in real-world clinical practice, focusing on patients with treatment-resistant migraine, defined according to the European Headache Federation (EHF) criteria as failure of at least three classes of preventive medications, including onabotulinumtoxinA or anti-CGRP monoclonal antibodies (mAbs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective multicentre study was conducted across 15 tertiary Headache Units in Spain. Demographic and clinical data, prior preventives, monthly headache days (MHD), monthly migraine days (MMD), and adverse events (AEs) were systematically collected at baseline, 3 months (primary endpoint), and\/or 6 months (secondary endpoint).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 513 patients were enrolled (mean age 48 years; 88% women). The 3-month analysis included 455 patients, with median MHD decreasing from 21 (IQR 15-30) to 14 (IQR 6-30) and MMD from 14 (IQR 10-20) to 8 (IQR 3-15) (both p &lt;\u20090.0001). A\u2009\u2265\u200950% reduction was achieved by 34% (MHD) and 29% (MMD), with \u226575% responses in 16% and 13%. Adverse events were mostly mild, mainly constipation (30%) and nausea (18%), and the 3-month discontinuation rate was 11.8%. Responders had shorter migraine chronicity, less analgesic overuse, and fewer prior preventive failures. Although prior inadequate response to anti-CGRP mAbs reduced the likelihood of improvement, it did not prevent meaningful benefit. At analysis, 151 patients had reached the 6-month visit, showing further improvement (MHD 10 [IQR 5-20]; MMD 6 [IQR 4-12]) and fewer adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Atogepant showed robust real-world effectiveness and good tolerability in a large, treatment-resistant migraine cohort, with clinically meaningful improvement at 3 months and incremental benefit in the subgroup evaluated at 6 months. Lower migraine chronicity and fewer prior preventive failures were associated with better outcomes, supporting the earlier introduction of anti-CGRP therapies in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinical Trials.gov NCT06241313<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03331024261431337","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T14:19:11Z","timestamp":1775053151000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Atogepant for migraine in real-world clinical practice: Insights from a large multicentre study in a treatment-resistant population (GEMA project)"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0038-3406","authenticated-orcid":false,"given":"Ana Beatriz","family":"Gago-Veiga","sequence":"first","affiliation":[{"name":"Hospital Universitario de la Princesa"},{"name":"Department of Neurology, Instituto de Investigaci\u00f3n Sanitaria Hospital Universitario de La Princesa, Madrid, Spain"},{"name":"Department of Medicine, Universidad Aut\u00f3noma de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0747-7966","authenticated-orcid":false,"given":"Ana Belen","family":"Lopez-Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Instituto de Investigaci\u00f3n Sanitaria Hospital Universitario de La Princesa, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Sanchez Jimenez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad Aut\u00f3noma de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Iglesias Rubio","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad Aut\u00f3noma de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Montes","sequence":"additional","affiliation":[{"name":"Hospital Universitario de la Princesa (IIS-Princesa)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Cami\u00f1a Mu\u00f1iz","sequence":"additional","affiliation":[{"name":"Hospital Universitario de la Princesa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Dominguez Gallego","sequence":"additional","affiliation":[{"name":"Hospital Universitario de la Princesa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Calle de Miguel","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Fuenlabrada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germ\u00e1n","family":"Latorre","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Fuenlabrada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Rodriguez-Vico","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz-UTE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Jaimes","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz-UTE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gomez Garcia","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz-UTE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Urtiaga","sequence":"additional","affiliation":[{"name":"Hospital de Torrej\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Gonzalez Salaices","sequence":"additional","affiliation":[{"name":"Hospital de Torrej\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Dileone","sequence":"additional","affiliation":[{"name":"Hospital Virgen del Puerto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Gonzalez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico San Carlos"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7034-682X","authenticated-orcid":false,"given":"Jes\u00fas","family":"Porta-Etessam","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz-UTE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8246-3743","authenticated-orcid":false,"given":"Mar\u00eda-Luz","family":"Cuadrado","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico San Carlos"},{"name":"Universidad Complutense de Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Herrero San-Martin","sequence":"additional","affiliation":[{"name":"Headache Unit, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7493-6002","authenticated-orcid":false,"given":"\u00c1ngel-Luis","family":"Guerrero-Peral","sequence":"additional","affiliation":[{"name":"Headache Unit. Department of Neurology, Valladolid Biosanitary Research Institute (IBIoVALL). Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesica","family":"Gonzalez-Osorio","sequence":"additional","affiliation":[{"name":"Headache Unit. Department of Neurology, Valladolid Biosanitary Research Institute (IBIoVALL). Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Casas-Lim\u00f3n","sequence":"additional","affiliation":[{"name":"Headache Unit, Department of Neurology, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"S\u00e1nchez-Soblechero","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Lozano-Ros","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"D\u00edaz-De-Ter\u00e1n","sequence":"additional","affiliation":[{"name":"Headache Unit, Department of Neurology, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Portocarrero-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Headache Unit, Department of Neurology, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco-Jos\u00e9","family":"Molina-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Headache Unit. Department of Neurology, Complejo Asistencial Son Espases, Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Santos-Lasaosa","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico Universitario Lozano Blesa"},{"name":"Universidad de Zaragoza"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Mart\u00edn-\u00c1vila","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Getafe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Riva","sequence":"additional","affiliation":[{"name":"Hospital Ruber Internacional"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Fern\u00e1ndez-L\u00e1zaro","sequence":"additional","affiliation":[{"name":"Department of Neurology, Instituto de Investigaci\u00f3n Sanitaria Hospital Universitario de La Princesa, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00034.2013"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.1996.1605310.x"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-025-01365-4"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-018-0617-4"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/17512433.2024.2417655"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035908"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01049-8"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201568"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00025-5"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024251374569"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-025-02068-2"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-024-00692-5"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024251346925"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024251370608"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024251335927"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024241305381"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1291439"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-020-01130-5"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_4_21_2","first-page":"1","article-title":"The package geepack for generalized estimating equations","volume":"15","author":"H\u00f8jsgaard S","year":"2006","unstructured":"H\u00f8jsgaard S, Halekoh U, Yan J. The package geepack for generalized estimating equations. J Stat Software. University of California at Los Angeles; 2006;15:1\u201311.","journal-title":"J Stat Software."},{"key":"e_1_3_4_22_2","unstructured":"Belgorodski N Greiner M Tolksdorf K et al. Fitting distributions to given data or known quantiles. R package version 2.1.2. 2017."},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-025-02239-1"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024251365206"}],"container-title":["Cephalalgia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03331024261431337","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03331024261431337","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03331024261431337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:44:24Z","timestamp":1777387464000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03331024261431337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/03331024261431337"],"URL":"https:\/\/doi.org\/10.1177\/03331024261431337","relation":{},"ISSN":["0333-1024","1468-2982"],"issn-type":[{"value":"0333-1024","type":"print"},{"value":"1468-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"article-number":"03331024261431337"}}