OBJECTIVE: To provide the first clinical report that 2 calcitonin gene-related 
peptide (CGRP) therapies, a small molecule CGRP receptor antagonist and an 
anti-CGRP receptor antibody, can be used concomitantly to treat refractory 
migraine.
METHODS: Case reports are presented of 2 patients participating in a long-term 
safety study of rimegepant 75 mg oral tablets for acute treatment (NCT03266588). 
After Food and Drug Administration approval of erenumab, both patients started 
subcutaneous erenumab monthly as allowed per protocol.
RESULTS: Patients were women 44 and 36 years of age with ≥2 decades of 
self-reported suboptimal response to multiple migraine medications. Patient 1 
used rimegepant for 6 months and then started erenumab 70 mg subcutaneous 
monthly. Despite a response to preventive treatment with erenumab, she 
experienced substantial relief treating 7 of 7 acute attacks with rimegepant and 
eliminated regular, frequent use of ibuprofen and a caffeinated analgesic. 
Patient 2 used rimegepant for 60 days before starting erenumab 140 mg 
subcutaneously monthly. While on erenumab, 9 of 9 attacks treated with 
rimegepant responded. She stopped near-daily use of injectable ketorolac and 
diphenhydramine. While using rimegepant alone or together with erenumab, 
patients reported no related adverse events.
CONCLUSIONS: Rimegepant 75 mg may be effective for acute treatment during 
concomitant erenumab preventive administration. The mechanism underlying the 
benefits of concomitant use of a small molecule CGRP receptor antagonist and an 
anti-CGRP receptor antibody is unknown and requires further study.
CLINICALTRIALSGOV IDENTIFIER: NCT03266588.
CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for 
patients with migraine using erenumab, rimegepant is effective for acute 
treatment.