Treating Menière’s disease with rimegepant

Abstract

A recent hypothesis states that Ménière’s disease (MD) is caused by the inappropriate expression, i.e. enhanced release of the neurotransmitter calcitonin gene-related peptide (CGRP). Here, we tested this hypothesis by administering rimegepant, a new CGRP antagonist approved for the acute treatment of migraine and for the prevention of episodic migraine, to six patients suffering from both MD and migraine. Two patients received the first dose of 75 mg rimegepant to treat an acute attack of MD. One of these two plus the remaining four patients were treated with 75 mg rimegepant every 2^nd day for secondary prevention. One patient developed an allergic reaction after the first administration and was excluded from further treatment. In the two patients treated during acute MD, symptoms were relieved and resolved about 30 min earlier than migraine symptoms. While all five patients had reduced migraine, all completely resolved Ménière's symptoms on preventive therapy with rimegepant for up to eight months. These results support the idea that CGRP is linked to the pathogenesis of MD and suggest that inhibition of CGRP signaling may represent a promising therapeutic option for MD patients.