An Overview of New Biologics for Migraine Prophylaxis

Philip Harvey, PharmD/MBA Candidate 2020; Pooja Shah, PharmD/MBA Candidate 2020; Scott Shipley, PharmD, BCPS

Disclosures

US Pharmacist. 2020;45(1):21-24. 

In This Article

Abstract and Introduction

Abstract

Migraine is a debilitating disorder that affects 37 million people in the United States. Recently, three new calcitonin gene-related peptide (CGRP) receptor antagonists—erenumab, fremanezumab, and galcanezumab—were FDA approved for prophylactic treatment of migraine. In clinical trials, these agents, which have no drug interactions and minimal adverse reactions, reduced headache days per month by as much as 50% in patients experiencing multiple migraine days each month. These new biologics, however, are more expensive for the patient compared with other prophylactic treatments. The patient should discuss with his or her physician whether a CGRP antagonist is the best therapy choice compared with other treatment options for migraine. The knowledgeable pharmacist will have an opportunity to educate patients on proper care and inform providers on appropriate use.

Introduction

Migraine is a debilitating disorder that affects 37 million people in the United States.[1] The addition of new biologics to the array of migraine treatments makes it necessary for pharmacists to learn how these products work and how they differ from existing therapies. It is essential for pharmacists to understand how the new biologics target a different system in order to effectively reduce or treat a patient's migraines.

Migraine management has significantly evolved over the past year with the release of new biologics. Historically, prophylactic treatment has involved the use of preventive medications, originally designed for different conditions, that do little for chronic or episodic migraine.[2] However, new biologics have been developed to target a specific substance in the brain—calcitonin gene-related peptide (CGRP)—that plays a key role in migraine pathophysiology.[3] By blocking the receptor function of CGRP, these agents can reduce the total number of headache days per month and limit the need for using multiple medications. Currently, three CGRP antagonists have been approved by the FDA for the preventive treatment of migraine in adults: Aimovig (erenumab-aooe; hereafter shortened to "erenumab"), Ajovy (fremanezumabvfrm; shortened to "fremanezumab"), and Emgality (galcanezumab-gnlm; shortened to "galcanezumab").

All three agents are injectables that, with proper counseling and guidance, may be administered by the patient at home. Table 1 provides a brief overview of each CGRP antagonist. A fourth CGRP antagonist, eptinezumab, is undergoing open-label safety studies and will not be discussed here.

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