HelixTalk Episode #88 - Powerful Peptides: CGRP and the Paradigm Shift in Migraine Prevention

Date posted: December 11, 2018, 6:00 am

In this episode, we will discuss a new class of medications for preventing migraines called CGRP antagonists, including an overview of their development, clinical efficacy, and future goals of further research in this area.

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Key Concepts

1. CGRP is not a new target for migraine prevention; it has been the source of many years of struggle in translational medicine.
2. Three new agents targeting CGRP have been approved since May 2018 (erenumab/Aimovig, galcanezumab-glnm/Emgality, fremanezumab-vfrm/Ajovy) with at least one additional agent on the way (eptinezumab).
3. Early data is very promising but a need for more cardiovascular data will likely be beneficial to avoid some of the same concerns with triptans.

References

• Deen M, et al. Blocking CGRP in migraine patients - a review of pros and cons. The Journal of Headache and Pain. 2017; 18:96.
• Dodick DW, Ashina M, Brandes JL, et al. ARISE: A Phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia. 2018; 38(6): 1026-37.
• Skljarevski V, Matharu M, Millen BA, et al. Efficacy and safety of galcanezumab for the prevention of episodic migraine: Results of the EVOLVE-2 Phase 3 randomized controlled clinical trial. Cephalalgia. 2018; 38(8): 1442-54.
• Dodick DW, Silberstein SD, Bigal ME, et al. Effect of fremanezumab compared with placebo for prevention of episodic migraine: A randomized clinical trial. JAMA. 2018; 319(19): 1999-2008.