Zavegepant Nasal Spray for Treatment of Acute Migraine: A Systematic Review

Abstract

Background: Migraine is a widespread neurological disorder that can impair quality of life. Current treatments are often insufficient, with side effects causing some patients to seek alternative options. Zavegepant nasal spray, a new treatment being developed for acute migraine, shows promise in blocking the CGRP receptor and providing several potential advantages, such as faster onset of action and higher bioavailability. This systematic review aimed to assess the efficacy and safety of Zavegepant nasal spray in treating acute migraine attacks and identify adverse events. Methods: Adult patients diagnosed with acute migraine who were treated with Zavegepant nasal spray in randomized controlled trials (RCTs) or non-randomized clinical trials were included. A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov until March 2023. The following keywords were employed: "Zavegepant nasal spray", "migraine", "calcitonin gene-related peptide receptor antagonist." A narrative synthesis was conducted to summarize and analyze the extracted data from the included studies, with a focus on the efficacy and safety of Zavegepant nasal spray for the treatment of acute migraine. Results: This systematic review included three clinical trials, of which two were RCTs, and one was an open-label trial. The total number of participants was 3681, and all of them were in phase 2/3 of testing. The inclusion criteria for these trials were broadly based on individuals who had a history of migraines with or without aura lasting for over a year, which is consistent with the third edition of the International Classification of Headache Disorder. The findings were tabulated and discussed. Conclusion: Zavegepant nasal spray is an effective and well-tolerated treatment for acute migraines. Further research is needed to confirm its safety and efficacy, optimal dosing and administration, and effectiveness in different populations. The cost-effectiveness, patient satisfaction, and long-term effects on migraine burden ought to be investigated.