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College of Pharmacy

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.

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.