Coming!! CGRP antibody for migraine prevention

CGRP (calcitonin gene-related peptide) antibody for migraine prevention

The big news in migraine treatment now is reports on clinical studies about CGRP.  Studies are now in phase 3 clinical trials with possible FDA approval of selected drugs next year (2018).  In the migraine process step 1 is trigeminal nerve activation.  Then in 20-40 minutes the ganglion of the trigeminal nerve and the artery start to release the neuroinflammatory chemicals:  CGRP, Neurokinin A, and Substance P.  (See category General Migraine, The Migraine Timing Cycle). These neurochemicals inflame the nerve, the artery, and the human pain center (the thalamus) and start arterial vasodilataion.  The CGRP antibody blocks the release of CGRP, one of the central neurochemicals involved with an attack of migraine.  A recent article posits that Botox injections also may block the release of CGRP as well as block the transmission of C and A sensory fibers.

Comments about CGRP:

1.      CGRP is released after nerve activation.

2.      Perivascular release of CGRP contributes to neurogenic inflammation by inducing vasodilation and dural mast cell degranulation.

3.      CGRP is involved in transmission of pain.

4.      CGRP levels have been found to be elevated during migraine attacks.

5.      Infusion of CGRP can induce migraine attacks in those susceptible to migraine headaches

The 18th Congress of the International Headache Society reported:

CGRP Monoclonals: Safe, Effective for Migraine in Phase 3 Trials

Daniel M. Keller, PhD

September 22, 2017

VANCOUVER, Canada — Phase 3 results of four monoclonal antibodies in development for the treatment or prevention of migraine, all of which inhibit signaling by calcitonin gene-related peptide (CGRP), suggest that in general, all performed similarly — both in efficacy, depending on the specific endpoints, and in safety and tolerability.

The main differences between the drugs, galcanezumab (Eli Lilly), fremanezumab (Teva Pharmaceuticals), eptinezumab (Alder Biopharmaceuticals), and erenumab (Amgen), were in doses, routes of administration, and the target of the antibodies.