Studies Show Promise for New Migraine Prevention Drugs
For people who live with chronic migraine, treatment is an often-frustrating combination of behavioral modifications, abortive medications, rescue medications and preventative medications — none of which are consistently effective for the majority of migraineurs. And none of the prevention medications used, such as antidepressants and epilepsy drugs, were developed specifically for migraine. Now, a new set of studies suggests a new class of drugs, developed especially to prevent migraine, may be on the horizon.
Two studies published in the New England Journal of Medicine on Thursday looked at calcitonin gene-related peptides (CGRP), which are located in central and peripheral neurons. The peptides influence pain and vascular activity in migraines, so the studies tested the effects of antibodies that have been developed to target either the CGRP receptor (erenumab) or the CGRP itself (fremanezumab).
“You have a kid next door making a lot of noise, you put in soundproofing and all of a sudden you’re quiet,” one of the studies’ authors, Stephen Silberstein, told NPR. “That’s what the antibodies do. They prevent the noise from aggravating the system.”
Erenumab was tested via monthly injection on 955 study participants with episodic migraine, or less than 15 headache days per month — in this case, their baseline was 8.3 migraine days per month. Participants received either 70 milligrams, 140 milligrams or a placebo. Of the patients who received 70 milligrams, the average number of migraine days per month was reduced by 3.2. Forty-three percent experienced a 50 percent or greater reduction in migraine days.
Of the participants who received 140 milligrams of erenumab, the number of migraine days was reduced by 3.7. Half experienced a 50 percent or greater reduction in migraine days.
A quarter of the participants in the placebo group experienced a 50 percent or greater reduction in migraine days.
In the fremanezumab trial, 1,130 patients with chronic migraine (a baseline of 20 headache days and 13 migraine days per month), received either monthly or quarterly injections or a placebo. Both of the fremanezumab groups experienced similar effects: about 40 percent of participants had a 50 percent or greater reduction in migraines, while only about 20 percent of those in the placebo group achieved the same effect. Both fremanezumab groups experienced about 4.5 fewer migraine days per month.
Though neither of these drugs are FDA-approved, both are in development with pharmaceutical companies. Amgen and Novartis sponsored the erenumab study and have filed for FDA approval. Teva Pharmaceuticals is developing a fremanezumab drug, which means one or both may hit the market in 2018.
These drugs aren’t likely to be low-cost. MarketWatch reported earlier this year that they’re expected to cost at least $8,500 a year, meaning they’ll likely be reserved for patients with severe migraine who haven’t been helped by other treatments.
Though researchers note more work is needed to study long-term safety of the drugs, they want the studies to give migraineurs hope.
“I hope it shows patients that this is not an impossible problem,” Peter Goadsby, one of the studies’ authors, told NPR. “It’s a tractable problem.”
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