Headache

New perspectives for chronic migraine

The last months saw the publication of large clinical trials on the efficacy of CGRP antibodies in chronic migraine. This offers a new perspective for patients suffering from chronic migraine (with or without medication overuse).

The last months saw the publication of large clinical trials on the efficacy of CGRP antibodies in chronic migraine. This offers a new perspective for patients suffering from chronic migraine (with or without medication overuse). Chronic migraine is the most severe form of migraine with a huge impact on quality of life and disability. To date, only botulinum toxin and topiramate had shown efficacy in clinical trials on this condition. The new CGRP antibodies have already shown efficacy in episodic migraine. In two recent trials, they were also studied in chronic migraine. One antibody against the CGRP receptor (erenumab) and one receptor against the ligand (fremanezumab) were studied in a double-blind placebo-controlled trial each. The study results were now published in highly respected journals showing a decrease of headache days per month by at least two days compared to placebo from the very beginning of treatment on. The drugs were very well tolerated with no side effects being more frequent than in the placebo arm. It is expected that the first CGRP antibody (erenumab) will be approved for clinical use in Europe in the second half of this year. It is not yet clear for which exact conditions the CGRP antibodies will be approved. Also, the costs and the way how to prescribe (by whom) are not determined yet but will be decided by the authorities in the near future.

 

key points

- chronic migraine

- CGRP antibodies

- clinical trials

 

Tepper S, Ashina M, Reuter U, Brandes JL, Doležil D, Silberstein S, Winner P, Leonardi D, Mikol D, Lenz R. Safety and efficacy of erenumab for preventivetreatment of chronic migraine: a randomised, double-blind, placebo-controlledphase 2 trial. Lancet Neurol 2017; 16: 425-434. PubMed PMID: 28460892

 

Silberstein SD, Dodick DW, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T,Grozinski-Wolff M, Yang R, Ma Y, Aycardi E. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med 2017; 377: 2113-2122. PubMed PMID: 29171818