There are numerous studies that suggest far more migraineurs should be on preventive therapy than are currently receiving it; the reasons cited most frequently by patients for not taking the available medications are lack of efficacy or intolerable side effects.
A new class of injectble monoclonal antibodies directed against calcitonin gene related peptide (CGRP) or its receptor may be the ideal agents to bridge this treatment gap.
There are 4 CGRP inhibitors in competition for FDA approval for migraine prevention:
Erenumab (co-developed by Amgen and Novartis) EREN
Fremenezumab (Teva) FREN
Galcanezumab (Eli Lilly) GALC
Eptinezumab (Alder Biopharmaceuticals) EPTIN
Erenumab binds the CGRP receptor; the others bind the CGRP ligand itself. Erenumab has a tentative FDA approval date of May 17, 2018, and the other three will likely follow throughout the summer and fall.
Trial results for erenumab and fremenezumab have been published and are summarized in the slides above.
1. Lilly's Galcanezumab Significantly Reduces Number of Migraine Headache Days for Patients with Migraine: New Results Presented at AHS [press release]. June 10, 2017. Accessed January 3, 2018.
2. Teva's Fremanezumab Meets all Primary & Secondary Endpoints Across Both Monthly and Quarterly Dosing Regimens in Phase III Study in Episodic Migraine Prevention [press release]. June 7, 2017. Accessed January 3, 2018.
3. Alder BioPharmaceuticals Announces Positive Eptinezumab Phase 3 Results for Prevention of Frequent Episodic Migraine [press release]. June 27, 2017. Accessed January 3, 2018.
4. Goadsby PJ, Reuter U1, Hallström Y, et al. A controlled trial of erenumab for episodic migraine. N Engl J Med. 2017;377:2123-2132. doi: 10.1056/NEJMoa1705848
5. Silberstein SD, Dodick DW, Bigal ME, et al. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med. 2017;377:2113-2122. doi: 10.1056/NEJMoa1709038.