Medication migraine research

CGRP: The hope

A friend of mine once said I would feel better if I stopped taking all my medications.

 

Sounds like 2017 will be a good year for migraines. We have the anti-CGRP treatments coming out. Something to look forward to when we have never really had much to look forward to.

Actually, there are more than four companies, developing both monoclonal antibodies that target CGRP or its receptor, as well as other small molecular drugs that target CGRP or other receptors that are widely considered to be important in turning of the pain and other symptoms associated with migraine. These results will become available at the same time that the American Migraine Foundation is launching their national public migraine awareness campaign.   It’s the first time that has ever happened. Dr. Dodick 

The medications target a compound called calcitonin gene-related peptide or CGRP. Researchers have known for some time that CGRP (which is a message carrying chemical) was involved with migraine attacks. But now they are targeting the neurotransmitter itself.

Over half of patients are seeing a 50% reduction in migraine frequency while using the CGRP drugs — some even more.  Dr. Peter Goadsby, director of the UCSF Headache Center in San Francisco, called it “a truly landmark development” that will offer many patients “freedom from the daily grind of being a migraine sufferer.”MigraineAgain

 

It is unique because it is the only preventative designed for migraines to date if it comes out. Every other one is off-label for migraines. This one was specifically targeted to migraines. So far indications are they will reduce frequency and intensity with very little side effects. With Half the patients seeing a 50% reduction. It will be a once a month medication as well which will be a nice perk.

And also how about This For both of the studies that have been fully reported, there are a small proportion of people who, at 3 months, it’s about 15% [whose migraine has disappeared], at 6 months, it’s a little over 10%, where their attacks stopped and didn’t come back.

Here are the two trials:

David Dodick, MD, studied with LY2951742; a humanized monoclonal antibody that binds CGRP. In a phase II he had 218 people with from 4 – 14 episodic migraine headache days per month, and randomly assigned them to get the antibody or a placebo. The medication was given every 2 weeks by injection.

Resulting with a reduction on average of 4.2 migraine days for those on the active drug compared to 3.0 days for those on placebo. 67 CGRP subjects and 47 placebo reported 50% drop in frequency. Mild side effects and self-limiting.

Peter Goadsby, MD r studied with ALD403; a humanized peptide antibody to CGRP.  This one was given intravenously at the start of the trial in an hour long infusion and not repeated.

There were 163 subjects with 82 on the medication and the remainder on the placebo. Average decline in migraines was 5.6 for the medication compared to 4.6 for placebo.

The proportion of patients with 50%, 75%, and 100% reduction in migraine days at week 12 was significantly greater in the ALD403 arm, Goadsby said. MedPage

I am very eager to try out such a promising medication. It is said to be, of course, rather expensive as well, so we will see how that works out. It is hard to say how it will perform, real world. From my experience with Botox, it wasn’t quite as significant as early studies suggested, but nevertheless a boon to those with chronic migraines. This seems to promising, I just don’t want to, well, jinx it.

 

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