Objective  To evaluate the efficacy and safety of atogepant in the prophylactic treatment of migraine.

Methods  The randomized controlled trials (RCTs) of atogepant in the prophylactic treatment of migraine were collected by searching PubMed, Embase, Cochrane Library, CNKI, VIP, WanFang and the SinoMed database. The experimental group was given atogepant, and the control group was given the placebo. The search time was from the inception to April 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software.

Results  3,552 patients in a total of 5 RCTs were included. The results of the Meta-analysis showed that compared with placebo, atogepant significantly reduced monthly migraine days [SMD=- 0.40, 95%CI(-0.48, -0.31)], monthly headache days [SMD=-0.40, 95%CI(-0.48, -0.31)], and acute medication use days [SMD=-0.45, 95%CI(-0.53, -0.36)], however, atogepant significantly increased the number of patients with ≥50% reduction in monthly migraine days [RR=1.83, 95%CI(1.40, 2.38)]. For safety, the total incidence of adverse reactions [RR=1.02, 95%CI(0.88, 1.20)], and the incidence of serious adverse reactions [RR=1.33, 95%CI(0.75, 2.33)] between two groups were not statistically significant (P>0.05).

Conclusions  Atogepant has shown good efficacy and safety in the prophylactic treatment of migraine patients. The above conclusions are limited by the quantity and quality of included studies and need to be verified by more high-quality research.

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