An Overview of New Biologics for Migraine Prophylaxis

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


US Pharmacist. 2020;45(1):21-24. 

In This Article

Guideline Update

Owing to the lack of extensive published data, the American Headache Society (AHS) included in its recent consensus statement information on CGRP receptor antagonists as emerging treatments for migraines.[16] These biologics have proven efficacy, safety, and tolerability for the prevention and treatment of both episodic and chronic migraine in phase II and phase III randomized, placebo-controlled clinical trials. The lack of a required dose titration and the rapid effects of treatment demonstrate the potential utility of these medications. Caution must be exercised in patients with long-standing chronic migraine and in those who have failed multiple prior attempts with preventive treatments. The efficacy and tolerability of these medications are patient-driven and may not replicate the endpoints used in clinical trials; however, they may be useful in practice if mean headache days per month are reduced and the patient has minimal side effects with effective results. According to the AHS, because these novel treatment options—unlike other first-line treatments—do not result in constriction of blood vessels, they may be useful in patients with cardiovascular contraindications. The absence of hepatic and renal metabolism and clearance means that there are no drug interactions with concomitant drugs, so these agents may be added to other injectable or oral therapies for the treatment and prevention of migraines. Response to the continuous use of CGRP antagonists is healthcare professional–dependent and should be guided by outcomes of reduction in mean migraine days per month, migraine-related disability, impact on and functional impairment of patients, and use for up to 3 months.[16]