Are new migraine preventive therapies meeting unmet needs?

Improved efficacy, tolerability, adherence, and quality of life and lowered total pain burden are all unmet needs in the management of #migraine. Evidence demonstrating that new preventive therapies—anti-calcitonin gene-related peptide monoclonal antibodies—are addressing these unmet needs and improving outcomes for patients was presented in a satellite symposium at EAN 2021.

Why are there unmet needs in the management of migraine?

Preventive medications used in the past have not been designed to treat migraine specifically, explained Professor Gregor Brössner, Innsbruck, Austria. They include beta-blockers, tricyclic antidepressants, anti-epileptics, and onabotulinumtoxinA.1

As a result, many patients have a history of discontinuing one or more preventive medications due to a lack of efficacy or adverse events and do not use preventive therapy.1

Many patients have discontinued preventive medications in the past due to a lack of efficacy or adverse events

Patients therefore use acute medications for their migraine episodes, but for some, this can lead to:

  • Medication overuse, as they increase the quantity and frequency of their acute medication to control their symptoms2

Use of acute medications to control migraine can lead to medication overuse headache

  • Medication-overuse headache (MOH),2 which is defined as a headache occurring on 15 days/month in a patient with a pre-existing headache disorder associated with regular medication overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache3

The worldwide prevalence of MOH is estimated to be at least 1–2% of the general population.4

 

Are new migraine preventive therapies addressing unmet needs?

The unmet needs in the management of migraine were identified by Dr Patricia Pozo-Rosich, Barcelona, Spain, as improved efficacy, tolerability, adherence, and quality of life, and lowered total pain burden.

Anti-CGRP mAbs exhibit a more favorable benefit-risk ratio than established migraine preventives

Evidence is now confirming that anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (anti-CGRP mAb) are effectively addressing these needs, she said, as demonstrated by:

  • A 2021 systematic review and likelihood to help or harm analysis, which concluded that anti-CGRP mAbs exhibit a more favorable benefit-risk ratio than established treatments for episodic and chronic migraine5
  • High adherence (defined by mean medication possession ratio and proportion of days covered over 6 months, which were 0.86 and 0.71, respectively) and persistence with therapy (defined as average length of therapy until first discontinuation, which was 128 days)6

Anti-CGRP mAb reduces the frequency, severity, and duration of migraine episodes

  • Improved quality of life based on improvements in the Patient Global Impression of Improvement—79.2% (95% confidence interval 75.7–82.4%) of patients who had been treated with anti-CGRP mAb within the previous 3 months reported their migraine condition as better since starting the anti-CGRP mAb7
  • Lower migraine total pain burden (ie, the frequency, severity, and duration of migraine episodes)8

 

This satellite symposium was funded by Eli Lilly.

 

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Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Blumenfeld AM, et al. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the Second International Burden of Migraine Study (IBMS-II). Headache 2013;53:644–55.
  2. Tepper D. Medication overuse headache. Headache 2017;57:845–6.
  3. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1–211.
  4. Diener H-C, et al. Efficacy, tolerability, and safety of eptinezumab in patients with a dual diagnosis of chronic migraine and medication overuse headache: Subgroup analysis of PROMISE-2. Headache 2021;61:125–36.
  5. Drellia K, et al. Anti-CGRP monoclonal antibodies for migraine prevention: A systematic review and likelihood to help or harm analysis. Cephalalgia 2021;41:851–64.
  6. Foster S, et al. Patient characteristics and utilization associated with galcanezumab initiation in patients with migraine. JMCP 2020;26:S51.
  7. Shapiro RE. CGRP monoclonal antibody use and patient-reported improvement of migraine: results of the OVERCOME study. MTIS 2020 Virtual Symposium, abstract MTV20-DP-002. Available at: https://conferences.medicom-publishers.com/disease/headache-and-migraine/improvement-of-migraine-using-cgrp-mabs-in-a-real-world-setting/. Accessed 25 June 2021.
  8. Ailani J, et al. Impact of galcanezumab on total pain burden: findings from phase 3 randomized, double-blind, placebo-controlled studies in patients with episodic or chronic migraine (EVOLVE-1, EVOLVE-2, and REGAIN trials). J Headache Pain 2020;21:123.
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