Comment on the first anti-CGRP drug designed to prevent migraine

 

June 2018

Dear AHS Member,

On May 17, 2018, the FDA approved erenumab (Aimovig), the first anti-CGRP; a class of drugs specifically designed to prevent migraine. This product is indicated for the preventive treatment of episodic and chronic migraine in adults. Anti-CGRP treatments represent a long-awaited disease-specific and mechanism-based treatment for the prevention of migraine. The anti-CGRP products have distinct differences and potential advantages over currently available oral preventive drugs, many of which were designed to treat other conditions such as epilepsy and hypertension. 

Monoclonal antibodies have several advantages over small molecules; they have high target specificity with minimal potential for off-target toxicity, are degraded and cleared within the reticuloendothelial system, do not undergo hepatic metabolism or renal clearance, and do not compete for binding sites.

Phase 2 and 3 trials for this class of treatments demonstrated efficacy in patients who have failed prior preventive drug therapy as well as those concurrently taking a migraine preventive drug. Additionally, these same trials demonstrate a tolerability profile that is similar to placebo. 

While long-term confidence in treating with anti-CGRP products will require broad exposure to heterogeneous patient populations in clinical practice, the advent of this class of treatments holds substantial promise for many. The anti-CGRP class should significantly increase the adherence of migraine patients to preventive medication; and therefore improve long-term outcomes. 

While we are optimistic that these medications will help many, they are likely to be used initially on those patients who have failed other preventive medications. Importantly, as with any novel treatment, the full benefit and risk profile of these agents in the migraine population will be characterized through broad exposure to patients in the clinical setting.    

Sincerely, 

Kathleen B. Digre, MD, FAHS
President, American Headache Society