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Tuesday, March 20, 2018

Recent developments in the prevention and treatment of migraine

Recent developments in the prevention and treatment of migraine
Katrina Mountfort, Freelance Medical Writer for Touch Medical Media, UK
Migraine is an under-recognised and undertreated neurological condition that imposes a considerable health and economic burden worldwide.1 In the 2015 Global Burden of Disease Study, migraine was the seventh leading cause of disability and the leading neurological cause of disability, accounting for over half of the years lost to disability among all neurological disorders.2 Prophylaxis remains the best treatment option for migraine; however, most preventative therapies in current use are designed to treat high blood pressure, epilepsy and depression.3 They lack efficacy in migraine, are not well tolerated and have slow onset of action and high discontinuation rates; a 2013 survey found that less than 50% of people with episodic and chronic migraine were using preventative medicine.4 Recent advances in our understanding of migraine pathophysiology may help address this unmet need. In particular, a new class of biological drugs has emerged that act directly on the brain circuits responsible for migraine. These are humanised monoclonal antibodies that selectively bind to and inhibit calcitonin gene-related peptide (CGRP) or its receptor, which are crucial components in migraine activation.5 Their long duration of action allows for infrequent dosing, at monthly or even quarterly intervals.
Four monoclonal antibodies are currently in development for migraine prevention: three that act directly on CGRP (fremanezumab, galcanezumab and eptinezumab) and one that acts on the CGRP receptor (erenumab). Erenumab (Novartis) has been studied in over 3,000 patients, including an ongoing open-label extension up to five years in duration, and was the first investigational therapy targeting the CGRP pathway to have received Food and Drug Administration (FDA) and European Medicines Agency (EMA) regulatory filing acceptance. In the STRIVE phase III study, erenumab administered subcutaneously at a monthly dose of 70 mg or 140 mg significantly reduced migraine frequency, the effects of migraines on daily activities, and the use of acute migraine-specific medication over a period of 6 months.6 Recently announced data from the phase IIIb LIBERTY study showed that, in patients with episodic migraine who had failed 2–4 prior preventive treatments for migraine, a significant percentage of patients on erenumab achieved at least a 50% reduction of migraine days compared with placebo.7 Erenumab has also demonstrated efficacy in a phase II study of patients with chronic migraine.8

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