CGRP Gepants: Quick Look
|Use||Treat moderate-to-severe migraines when they start (acute treatment); likely to be offered as a first-line option to people who cannot take triptans.|
|Effectiveness||Large, high-quality clinical trials prove they work.|
|Side effects||Infrequent: Nausea, sleepiness, dizziness|
|Taken how?||Different formulations are available:|
|Drugs in this class|
How are gepants different from triptans?
Triptans constrict blood vessels and gepants do not.2 Gepants may be an option for people with heart or blood vessel disease.1 Triptans may not be safe for this group of people.
A deeper dive into the science explains this difference. Gepants work by binding to—or connecting with—the CGRP (calcitonin gene-related peptide) receptor.3,4 CGRP is a chemical messenger in the brain. CGRP has a role in pain processes and in relaxing the blood vessels.5 CGRP goes up during a migraine attack. By blocking the CGRP receptor, gepants stop these processes and stop the migraine.
Triptans work by binding to certain serotonin receptors. Some of the serotonin receptors cause blood vessels to constrict. This effect may have a role in relieving migraine. It also makes triptans unsafe for some people with heart or vessel disease.
How are CGRP gepants different from CGRP monoclonal antibodies?
The gepants and the monoclonal antibodies both target CGRP. However, these classes of medication have different uses. Gepants are acute (or abortive) treatments taken at the start of a migraine.3,4CGRP monoclonal antibodies are taken to prevent migraine.
Another difference is how they are taken. Gepants are taken by mouth.3,4 Monoclonal antibodies are taking by injection or infusion. The reason is that they are made differently. Gepants are conventional drugs.6 This means that they are made in a laboratory using chemistry. They can be absorbed when taken by mouth.
Monoclonal antibodies are biologic drugs. Biologic drugs are proteins made by the cells of living organisms. If you were to take a monoclonal antibody by mouth, your body would digest it before it could work. For this reason, monoclonal antibodies must be injected.
How well do gepants work?
Large, high-quality studies of people treated with gepants showed that:7,8
- 20 percent are pain free at 2 hours.
- 60 percent have pain relief at 2 hours.
- 35 percent are free of their most bothersome migraine symptom at 2 hours.
- 36 percent to 48 percent have sustained pain relief 24 hours after treatment.
These results are based on groups of study participants. These results do not tell you whether a medication will work for you personally.
What are the possible side effects of gepants?
People treated with gepants in clinical trials did not have a lot of side effects. None of the side effects were serious.
The most common side effects of Nurtec were nausea and hypersensitivity reactions (dyspnea and rash).9 The most common side effects of Ubrelvy were nausea, sleepiness, and dry mouth.8 These side effects affected fewer than 2-3 percent of study participants. There were just as many side effects in the people who got no treatment (placebo).
Medication overuse headaches are unlikely to be a problem with gepants.2
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