From the Guidelines
Nurtec and Qulipta are not interchangeable, and their use should be guided by their specific FDA approvals and the individual patient's needs. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1, both Nurtec (rimegepant) and Qulipta (atogepant) are CGRP antagonists used for migraine treatment, but they have distinct differences in their approved uses. Nurtec is approved for both acute treatment of migraine attacks and preventive treatment, whereas Qulipta is specifically approved for preventive treatment of episodic migraines.
Key differences between the two medications include:
- FDA approval: Nurtec is approved for both acute and preventive treatment, while Qulipta is approved only for preventive treatment.
- Dosing regimen: Nurtec is taken as needed for acute attacks or every other day for prevention, while Qulipta is taken daily for prevention.
- Indications: Nurtec can be used for both acute and preventive treatment, while Qulipta is used for preventive treatment only.
The guideline states that there is insufficient evidence to recommend for or against any specific medication over another for the short-term treatment of migraine or for the prevention of migraine headache 1. However, it does provide recommendations for the use of CGRP-acting agents, including CGRP monoclonal antibodies and gepants, which have shown efficacy in reducing migraine frequency and severity 1.
In terms of side effects, both medications have favorable profiles, with nausea and stomach discomfort being the most common adverse effects. However, patients should not substitute one medication for the other without consulting their healthcare provider, as the choice of medication depends on individual factors such as response to treatment, side effect profile, and insurance coverage.
Ultimately, the decision to use Nurtec or Qulipta should be based on the individual patient's needs and medical history, and should be made in consultation with a healthcare provider. The guideline emphasizes the importance of working with patients to craft treatment plans that account for headache type, comorbid conditions, and values and preferences 1.
From the Research
Comparison of Nurtec and Qulipta
- Nurtec (rimegepant) and Qulipta (atogepant) are both calcitonin gene-related peptide (CGRP) receptor antagonists used for the treatment of migraine 2, 3.
- Nurtec is approved for the acute treatment of migraine with or without aura in adults, and for the preventive treatment of episodic migraine in adults 2.
- Qulipta is approved for the preventive treatment of episodic migraine in adults 3.
Efficacy and Safety
- Rimegepant (Nurtec) has been shown to be effective in relieving pain and reducing the number of monthly migraine days when taken as needed for acute treatment or every other day for preventive treatment 2.
- Atogepant (Qulipta) has been shown to be effective in reducing monthly migraine days and improving quality of life when taken for preventive treatment 4, 3.
- Both rimegepant and atogepant have been found to be generally well-tolerated, with no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 2, 4.
Substitution
- There is no direct evidence to suggest that Nurtec is an appropriate substitute for Qulipta, as they have different approved indications and dosing regimens 2, 3.
- However, both medications belong to the same class of CGRP receptor antagonists and have similar mechanisms of action, which may suggest some similarity in their effects 5.
- The decision to substitute one medication for another should be made on a case-by-case basis, taking into account individual patient needs and medical history 6, 5.