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CNS Drugs
Published in: CNS Drugs 11/2019

01-11-2019 | Migraine | Current Opinion

Recent Advances in Pharmacotherapy for Episodic Migraine

Authors: Calvin Chan, Peter J. Goadsby

Published in: CNS Drugs | Issue 11/2019

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Abstract

In 2018, three calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies, erenumab, fremanezumab and galcanezumab, were approved in various parts of the world, including Europe and the US, and another, eptinezumab, is pending, for the prevention of migraine. In this article, episodic migraine treatment is reviewed, although these medicines are approved and are just as effective for chronic migraine. These new medicines usher a new phase in the preventive management of migraine with migraine-specific treatments. Data from phase III trials of CGRP pathway monoclonal antibodies have shown they are efficacious, with adverse effect rates comparable to placebo. The combination of clear efficacy and excellent tolerability will be welcome in an area where poor adherence to current preventives is common. Rimegepant, ubrogepant and lasmiditan are migraine-specific acute therapies yet to be approved by regulators. Phase III data for the respective CGRP receptor antagonists, the gepants, and the serotonin 5-HT1F receptor agonist, the ditan, have been positive and free of cardiovascular adverse effects. These medicines are not vasoconstrictors. When approved, they could meet the acute therapy demand of patients with cardiovascular risk factors where triptans are contraindicated. Beyond this, gepants will see the most disruptive development in migraine management in generations with medicines that can have both acute and preventive effects, the latter evidenced by data from the discontinued drug telcagepant and the early-phase drug atogepant. Moreover, one can expect no risk of medication overuse syndromes with gepants since the more patients take, the less migraines they have. During the next years, as experience with monoclonal antibodies grows in clinical practice, we can expect an evolution in migraine management to take shape. Clinicians will be able to offer treatment patients want rather than trying to fit migraineurs into therapeutic boxes for their management. Despite pessimistic susurrations of a largely addlepated form, many patients, and physicians, will welcome new options, and the challenges of new treatment paradigms, with optimism.
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Metadata
Title
Recent Advances in Pharmacotherapy for Episodic Migraine
Authors
Calvin Chan
Peter J. Goadsby
Publication date
01-11-2019
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 11/2019
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-019-00665-9

Other articles of this Issue 11/2019

CNS Drugs 11/2019 Go to the issue

Review Article

The Potential Therapeutic Capacity of Inhibiting the Brain Renin–Angiotensin System in the Treatment of Co-Morbid Conditions in Epilepsy

Original Research Article

Relative Seizure Relapse Risks Associated with Antiepileptic Drug Withdrawal After Different Seizure-Free Periods in Adults with Focal Epilepsy: A Prospective, Controlled Follow-Up Study

Original Research Article

Treatment with Dimethyl Fumarate Enhances Cholinergic Transmission in Multiple Sclerosis

Systematic Review

Effects of Fampridine in People with Multiple Sclerosis: A Systematic Review and Meta-analysis

Review Article

Risk Factors Associated with the Occurrence of Neonatal Opioid Withdrawal Syndrome: A Review

Leading Article

Targeting Iron Dyshomeostasis for Treatment of Neurodegenerative Disorders