Rimegepant 75 mg showed no significant benefit over placebo for facial pain, nasal congestion, or discharge in 261 chronic rhinosinusitis patients, despite CGRP's proposed role in the disease.
No benefit (p>0.05)Single-dose CGRP receptor blockade did not improve any CRS symptom outcome over placebo
What the researchers found
No significant treatment differences between rimegepant and placebo for primary (facial pain NRS, -0.1 [95% CI -0.7 to 0.5]) or secondary outcomes (nasal congestion, discharge, TNSS, headache relief, rescue medication use).
Why it matters
This negative result is informative: despite biological plausibility, CGRP blockade does not appear to help CRS. This narrows the therapeutic scope of anti-CGRP drugs and redirects CRS research.
How the study worked
Double-blind, randomized, placebo-controlled, phase 2/3 trial (NCT05248997) with 261 adults with CRS (131 rimegepant, 130 placebo), stratified by nasal polyp status.
What this study cannot tell us
Single-dose design may be insufficient. CRS is a chronic condition that may need sustained treatment. Small evaluable sample (96 vs 100). CGRP's role in CRS may require different intervention strategies.
How to read the evidence
Well-designed phase 2/3 RCT. Negative result is definitive for single-dose rimegepant in acute CRS symptom relief.
When this study was published
Published in 2025.
The bigger picture
Not every condition involving CGRP will respond to CGRP blockade. This trial helps define the boundaries of anti-CGRP therapy and informs future CRS research directions.
Questions still open
- Would repeated dosing of rimegepant show different results in CRS?
- Is CGRP's role in CRS downstream of other inflammatory processes?
- Could combination CGRP + other anti-inflammatory therapy benefit CRS?
Common questions
Can migraine drugs help with chronic sinusitis?
Why did they think it might work?
Read the original research
Efficacy and safety of rimegepant 75 mg orally disintegrating tablet for the acute treatment of chronic rhinosinusitis in adults: Results from a multicenter, randomized, placebo-controlled, phase 2/3 trial.
PloS one, 21(3), e0342907
Citation
Franjic, Daniel; Fountaine, Robert J; Nalpas, Catherine; Goswami, Budhaditya; Fullerton, Terence. (2026). Efficacy and safety of rimegepant 75 mg orally disintegrating tablet for the acute treatment of chronic rhinosinusitis in adults: Results from a multicenter, randomized, placebo-controlled, phase 2/3 trial.. PloS one, 21(3), e0342907. https://doi.org/10.1371/journal.pone.0342907