CGRP Antagonists are the New Triptans

The American Headache Society (AHS) held its 57th Annual Conference in June 2015 in Washington, DC. The buzzword this year was CGRP, which stands for Calcitonin Gene-Related Peptide. A peptide is a molecule consisting of two or more amino acids. CGRP has 37 amino acids and is produced in the peripheral and central neurons. Most importantly, the function of CGRP is to transmit pain.

Triptans

The last time a drug came out that was specifically targeted for Migraine relief was in the early 1990s when triptans were introduced in the market. Maxalt, Relpax, Imitrex, Zomig are all in the triptan class of drugs and are now household names. Triptans help a large population of Migraineurs when taken at the onset of an attack.

CGRP Antagonists

CGRP antagonist drugs are being designed as a preventative, not an abortive like triptans. These new drugs contain human monoclonal anti-bodies that blocks the CGRP receptor. Reducing elevated levels of CGRP is believed to reduce or prevent pain. If these drugs pass through FDA approval, they would be the first treatment to ever prevent Migraines.

Other Preventatives

Patients currently have many options to take on a daily basis to prevent attacks, but all of these drugs were originally designed to help a different population of patients. Anticonvulsants (like Depakote and Topamax) were created to help Epileptic patients. Anti-depressants (like Zoloft and Effexor) are used widely for Migraineurs, but clearly were intended to help those with depression. Calcium channel blockers (like Verapamil) is a medicine used to control high blood pressure. Beta Blockers (like Inderal) are also used to treat hypertension.

Over time, doctors found that using these drugs off-label for Migraine patients had a positive effect on Migraine prevention. The possibility of a new drug designed specifically to prevent Migraines is very exciting news. Unfortunately, it may still be a few years away before you can get your hands on one of them.

Status of Current Trials

There were three pharmaceutical companies on hand at the AHS conference to discuss their clinical trials testing their new CGRP antagonist drugs; Amgen Pharmaceuticals, Eli Lilly and Company and Teva Pharmaceuticals. The main purpose of all of the medications was to see a reduction in the number of Migraine days per month. All three companies are in Phase II trials of their drugs.

Each study administered their anti-CGRP drug via intramuscular injection at varying doses versus a placebo. Participants were considered episodic Migraineurs, having between four and 14 Migraine days per month or eight and 14 Migraines days per month for the Teva Pharmaceutical drug. Each study had between 200 and 500 participants. In the Teva Pharmaceutical trial, patients were allowed to stay on their current medication regimen to prevent or abort Migraines. It is unknown whether the other two trials allowed the same.

Conclusion:

All three studies study reached their primary endpoint of reducing the number of headache days as compared to the participant’s baseline prior to administration of the drug. Specifically, Amgen Pharmaceuticals trial saw that after 12 weeks of use, 46.5% of participants in the highest dose category of 70mg, had an overall reduction in the amount of Migraine days per month. The average reduction in Migraine days was 3.4 days per month for these study participants.

This is extremely exciting news for the Migraine community. Each pharmaceutical company still has to complete additional studies before obtaining FDA approval, a task which could take another 1-3 years. Having an antagonist CGRP medication would be the first time a drug has been specifically made for the prevention of Migraine headaches. This is a huge win for Migraineurs!

For more in-depth study information, please see:

http://www.amgen.com/media/media_pr_detail.jsp?releaseID=2048511

https://investor.lilly.com/releasedetail.cfm?releaseid=918405

http://www.tevapharm.com/news/?itemid=%7B007EDCEC-98E8-41EA-8775-2F4E78BB12E6%7D

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (8)
  • Kim Leonoudakis
    4 years ago

    Also check out the company Trigemina.com they will probably do a trail next year. So far they are having great success rates outside of the U.S.

  • Elizabeth
    4 years ago

    Will this be something that Hemiplegic Migraine patients can try? I have Chronic Migraines and Hemiplegic Migraines. I have tried to be involved in many research trials and am always turned away because of my Hemiplegic Migraines.

  • Lori
    4 years ago

    Hmmm…. so this new class of drugs will reduce the number of migraine attacks for episodic migraineurs from an average of 4-14 per month down to approximately 1-11 attacks per month.
    As a migraineur for more than 45 years, with the last 15 of those years a sufferer of more than 20-30 attacks per month, I don’t have a lot of hope for a drug that “might” promise 3 fewer attacks per month. And I’m concerned that only episodic migraineurs have been tested. Perhaps as the testing gets further down the pipeline as it it brought to market, testing will be performed on chronic migraineurs.

  • Judy H
    2 years ago

    I have to agree with you, Lori. In my case I have spent 40+ years with migraine, have tried just about everything. My migraines became & have stayed worse since menopause: I don’t even know any migraines now that last less than 3 days each. I use my precious vacation days for migraine because I use my sick leave as soon as I accrue it. Knowing that I have no vacation prospects is stressful – which does not help. Fortunately I have a boss who understands. I was the first patient my doctor AND pharmacy had who experienced Imitrex, such is my history. 3 fewer attacks per month is a drop of water in a very big ocean… The older I get, the more side effects with these drugs…

  • Joanna Bodner moderator
    2 years ago

    Hi there Judy H,
    I am so sorry to hear how difficult managing work and migraines has been for you. For many, work tends to be one of the biggest stressor and I am sorry that you too must contend with this along with increased side effects. This must be extremely challenging. If you don’t mind me asking,and although you have an understanding boss, have you looked into or considered disability? Here is an article you may find helpful to review – https://migraine.com/blog/disability-means-not-mean/. Thanks taking the time to comment. -Joanna (Migraine.com Team)

  • Karen Rudd
    4 years ago

    While hopeful for a new treatment, I have had negative reactions to so many meds, I have learned not to get my hopes up. The last class, triptans, are a godsend for many migraineurs. Unfortunately, my body hates them, each of them cause a pronounced increase in blood pressure and an immediate marked increase in pain. Thank you for adding this article, and asking so many aware of a potential new weapon in our fight. I’ve had chronic intractable migraines for 42 years now, complicated for the last 15 with fibromyalgia.

  • The Migraine Girl moderator
    4 years ago

    Thanks for this thorough reporting!

  • mammapeaches (Susan McManus)
    4 years ago

    This sounds promising! Hopefully, it won’t take too long to get approved. I am sure that I am not the only one that has had no success with other preventatives and now Triptans don’t always work. Running out of options!

  • Poll