CGRPs: New Help in Migraine Prophylaxis?

A new class of injectable monoclonal antibodies directed against calcitonin gene related peptide (CGRP) or its receptor may offer hope to migraineurs who have not found effective prophylactic therapy.

CGRP is a key neuropeptide in the pathophysiology of migraines. Four CGRP inhibitors are currently competing for FDA approval for migraine prevention:

Erenumab (co-developed by Amgen and Novartis)    
Fremenezumab (Teva)                                               
Galcanezumab (Eli Lilly)                                             
Eptinezumab (Alder Biopharmaceuticals)                   

Details about these agents can be found in this slideshow.1

Erenumab binds the CGRP receptor; the others bind the CGRP ligand itself.

Details of a preliminary study of erenumab, supported by Novartis Pharma AG, will be presented on Wednesday, April 25, at the American Academy of Neurology 2018.

This study included 246 people who had episodic migraine; participants were given injections of either 140 mg of erenumab or a placebo once a month for 3 months. Just over a third of the participants had been treated unsuccessfully with 2 other medications, another third with 3 medications, and a quarter with 4 drugs. Participants experienced an average of 9 migraines a month and used an acute migraine drug 5 times a month.

After 3 months, the erenumab recipients were nearly 3 times more likely to have 50% or more fewer migraine days than placebo recipients; and 30% of those treated with erenumab had half the number of headaches vs 14% in the placebo group. Safety and tolerability of the active drug were similar to those of placebo.

In a statement to the press, study author Uwe Reuter, MD, of The Charité – University Medicine Berlin in Germany noted, “Our results show that people who thought their migraines were difficult to prevent may actually have hope of finding pain relief. More research is now needed to understand who is most likely to benefit from this new treatment.”

A limitation of the study is its relatively short length of 3 months. More research is needed to determine whether benefits continue.

More information about migraine is available from the AAN here.

Disclosures:

1. Hackethal V.  CGRP inhibitors reduce migraine frequency, disability. www.PatientCareOnline.com. Jan 9, 2018.