CGRP Inhibitor Vyepti Adds a New Dimension to Preventive Migraine Treatment
Vypeti, the much anticipated new CGRP monoclonal antibody, is creating a buzz in the migraine community. 2018 saw a dramatic shift in preventive migraine treatment with the emergence of the first-ever medications specifically designed to prevent migraine, and now we see a fourth, innovative CGRP inhibitor joining the lineup.
During a time when attention is being partially diverted to three new abortive treatments, Vyepti, a new preventive option, has been FDA approved and is about to be available on the market.1
What is Vyepti?
Vyepti, also known as eptinezumab, is an IV prescription medication by Lundbeck for the preventive treatment of migraine in adults. FDA approved on February 21, 2020, it is expected to be available in doctors’ offices in April 2020. Headache specialists around the USA are currently preparing to be trained in the administration of this novel CGRP inhibitor medication.
What is important to know about Vyepti?
- Vyepti is given as either a 100mg or 300mg dose via IV infusion every three months in a doctor’s office.
- It is FDA approved for adults with episodic or chronic migraine.
- Studies included patients on a stable dose of acute or preventive medication, except those on Botox.
- Studies included chronic migraine patients with a dual diagnosis of medication overuse headache.
- The half-life of Vyepti is approximately 27 days in healthy patients.
- Vyepti attaches to the CGRP peptide similarly to the mechanism with Ajovy and Emgality. This stops the peptide from attaching to the receptor.2
What is the efficacy of Vyepti?
- For episodic migraine, 49.8 to 56.3 percent of people experienced at least a 50 percent reduction in migraine days, and 22.2 to 29.7 percent had at least a 75 percent reduction, depending on dosage.
- For chronic migraine, 57.6 to 61.4 percent of people experienced at least a 50 percent reduction in migraine days, and 26.7 to 33.1 percent of people had at least a 75 percent reduction, depending on dosage.
- Due to the form of administration, bioavailability can be expected to happen sooner than with the injectable CGRP inhibitors. Some participants in the trials reported efficacy as soon as one day after the infusion, while others waited longer to see results.
- Similar to the injectable CGRP inhibitors, even with early efficacy, the results can continue to improve for several months.3
Safety and contraindications
As with all other new medications, the hot question is often about side effects. Not surprisingly, that is the same with Vyepti. This is even more so due to the previous three CGRP inhibitors (Aimovig, Ajovy, and Emgality) showing a significantly different side effect profile than that reported from the clinical trials.
Patients understandably are nervous and desperation for relief from migraine attacks is often being balanced against potential risk. Side effects seen most frequently in the clinical trials for Vyepti were stuffy nose, scratchy throat, and allergic reaction, however, it remains to be seen how it responds in real-life use.
It is important to know that Vyepti studies excluded patients with a history of cardiovascular, cerebrovascular and neurological disease besides migraine. They also excluded patients using opioids or butalbital-containing products greater than 4 days per month, as well as those taking Botox. These exclusions are likely to cover a large majority of patients who will be eligible for this medication, and as a result, there are many more unknowns than knowns.
As this fast-acting IV medication makes its way into doctors’ offices, it’s important for patients to go into the process of understanding that as well as being prepared to partner with their doctors in treatment. The doctor-patient relationship is rapidly changing as an ineffective and impersonal compliance model is replaced with one of partnership and collaboration. Advocating for yourself, becoming informed, and speaking up about any concerns is an essential part of your own disease management.
Is Vyepti worth trying?
It’s not an easy question to answer whether Vyepti is worth trying for any individual person since each of our situations are so unique! The following questions are important to discuss with your doctor as your partner in your migraine management:
- What is your level of disability from migraine and do you have any other preventive options?
- Are you currently taking too much abortive medication (either prescription or OTC)?
- Are you more comfortable with an IV infusion at a doctor’s office than a self-injection done at home?
- If you tried one or more of the CGRP injectables, did you experience efficacy at least for a while?
- If you tried one or more of the CGRP injectables, did you experience intolerable or lasting side effects?
- Do you have a comorbid condition that was excluded from the Vyepti clinical trials?
- What is your level of comfort in trying a new medication that has a long half-life?
If you’re still undecided, try discussing these questions with your doctor, or ask questions on one of the many migraine support groups. Bear in mind that online groups often talk about the negative experiences with new medications. However, there are also a lot of positive and encouraging posts to help you come to a decision. Even just knowing that there is an online community where you can share your journey can be enough to encourage you to try something new!
The rollercoaster continues
And so, the rollercoaster continues! It’s a rollercoaster of hope versus fear and success versus failure. It’s a journey that none of us wants to be on but here we are… on this journey together. Hold on to that!
We’re in this together, exploring new options for a disease that until recently has seen nothing new for decades. We’re able to share information, share experiences, and lift each other up as we reach towards the ultimate goal of effective tolerable treatment and maybe, just maybe, one day a cure!
Has this journey exploring new migraine treatments been a rollercoaster for you? What are your thoughts about trying Vyepti? Are you a “wait and see” or a “jump in with both feet” kind of person? We’d love to hear from you!
Can you tell when a migraine attack is coming?