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The US Food and Drug Administration (FDA) has approved the oral CGRP receptor antagonist, Qulipta (atogepant) for the preventive treatment of episodic migraine in adults. The drug will be available as once-daily treatment in three doses – 10 mg, 30 mg and 60 mg. The approval is supported by data evaluating the efficacy, safety and …

Since the US approval of the first gepant for the acute treatment of migraine in December 2019, clinicians have been reporting their experiences of combining these agents with CGRP monoclonal antibodies (mAbs) in some patients. Richard Lipton, Edwin S Lowe Professor of Neurology at the Albert Einstein College of Medicine, New York, USA, discusses the …

Real world studies are showing that CGRP mAbs are effective in significant patient groups excluded from randomised controlled trials (RCTs). They are also helping to identify predictors of treatment response and are extending understanding of safety issues. Professor Uwe Reuter, from the Charité University Berlin and the University of Greifswald, Germany, discussed data from the …

Stopping preventive treatment with CGRP mAbs typically leads to worsening migraine symptoms and, in some cases, a rebound effect, according to reports from clinicians in Germany, Portugal and Italy. Results of a German longitudinal study of 62 patients who received erenumab, fremanezumab or galcanezumab for at least eight months showed that mean monthly migraine days …

Twelve month data from the HALO study and six month results from the FOCUS study have shown few blood pressure-related adverse events with fremanezumab and minimal changes in systolic blood pressure (SBP) or diastolic blood pressure (DBP). In HALO, one patient had increased DBP and one had decreased SBP, both with quarterly fremanezumab. Mean blood …

Erenumab and galcanezumab have demonstrated similar efficacy and safety as preventive treatment in a very difficult-to-treat migraine population in Spain. Data were reported on 220 patients, 89% of whom had chronic migraine. Patients had failed on a mean 5.74 previous preventive therapies. With erenumab, monthly headache days (MHDs) decreased from 20.94 days at baseline to …

Long term acute treatment of migraine with rimegepant 75 mg as needed is associated with clinically relevant reductions in monthly migraine days (MMDs), according to post hoc results from an open label, 52-week safety study. There was no evidence of medication-related increases in headache frequency. In the study of 1,044 participants with ≥6 MMDs, the …

Real world experience from multiple new reports worldwide supports the use of CGRP mAbs in the treatment of cluster headache. From Korea, researchers reported results from 45 patients with episodic cluster headache who received at least one dose of galcanezumab 240 mg in two prefilled syringes of 120 mg.1 Patients took a range of preventive …

No new safety signals have been identified in the ADVANCE open label extension study of atogepant 60 mg once daily for 40 weeks, with a 4-week safety follow-up period. Of the 685 patients who rolled over from the ADVANCE trial and took at least one dose of study drug, 74.6% completed the 40-week treatment period. …

Approximately one in three non-responders to initial CGRP mAb treatment may benefit from switching to another antibody, according to results of two real world reports. In a retrospective cohort study of 25 non responders to erenumab (<30% reduction of monthly headache days [MHD] after three cycles), eight patients (32%) achieved a >30% reduction in MHD after switching …

High levels of patient satisfaction have been reported in an analysis of data from 302 US adult Migraine Buddy users who self-reported using at least four doses of ubrogepant, one in the preceding 14 days. Of the sample, 75.8% reported being satisfied with ubrogepant for pain relief at 2 hours, 83.4% at 4 hours and …

Long-term, real world experience with erenumab in high frequency episodic migraine (HFEM) and chronic migraine (CM) has shown sustained effectiveness, safety and tolerability in patients who failed on at least three previous preventive therapies. The results, from the 48-week EARLY 2 study in 15 Italian centres, also showed that responsiveness was positively associated with cutaneous …

The ADVANCE study showing that atogepant significantly reduced mean monthly migraine days (MMDs) over 12 weeks has been published in the New England Journal of Medicine. In the efficacy analysis of 873 patients, MMDs were reduced from a baseline of 7.5-7.9 days by 3.7 days with atogepant 10 mg, 3.9 days with atogepant 30 mg …

Ajovy (fremanezumab) and Emgality (galcanezumab) have been approved for inclusion on the Pharmaceutical Benefits Scheme (PBS) in Australia for prescription to patients with chronic migraine. This means that the cost of treatment will be subsidised by the Australian government. Patients will need to fulfil three criteria to benefit from reduced pricing: A diagnosis of chronic …

Erenumab may be an effective and well tolerated therapy for patients with medically refractory, chronic migraine with and without medication overuse, according to results of a prospective single centre real world audit of patients treated for six months. The 162 patients in the audit had failed a mean of 8.4 preventive treatments at baseline, and …

In complex patients with multiple treatment failures, good responder rates are seen with anti-CGRP mAbs irrespective of previous poor response to botulinum toxin A (BTX-A), but dual therapy with anti-CGRP mAbs and botulinum toxin A does not appear to add more benefit compared to anti-CGRP mAb monotherapy.1 These were the findings from a real world …

European migraine specialists have urged head-to-head studies of preventive therapies, including CGRP monoclonal antibodies (mAbs), topiramate and botulinum toxin A. This follows two recent systematic reviews with meta-analyses showing that all three treatments have superior efficacy to placebo but topiramate has a less favourable safety profile and higher drop out rate compared to the other …

Galcanezumab significantly reduces mean weekly total pain burden in patients with episodic cluster headache, according to results of a post hoc analysis of the Phase 3 study which supported US approval of galcanezumab in the indication. The new analysis, aimed at addressing the multiple pain dimensions that may contribute to the total burden of episodic …

Clinicians are being encouraged to report experiences of switching patients between CGRP mAbs in order to better understand potential benefits and inform treatment access policies of payers and care providers. A report of seven patients with chronic migraine and prior treatment with three to 14 preventive drugs (mean 9.5) has demonstrated the impact of switching …

Two cases of restless legs syndrome (RLS) have been described in patients with chronic refractory migraine using CGRP mAbs, although the authors of the report stress that caution is needed before establishing a causal relationship. The affected patients developed typical RLS symptoms 1.5 and four months after starting erenumab 140 mg, respectively. In the first …