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What’s New for Migraines?

Welcome back everyone, I hope you had a wonderful holiday season and best wishes for a safe and happy new year.


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In this edition of Ron’s Clinical Corner, I want to provide you with some of the more recent approvals for medications used in the treatment of migraine headaches.

In the United States, close to 40 million people over the age of 12 suffer from migraine headaches, with women being 3 times as likely as men to experience them(1). Many different therapies exist both for the prevention and treatment of migraine headaches but recently, a few new medications have been approved.

In October 2019, the FDA approved Reyvow®, an oral 5-HT 1F receptor agonist, for treatment of acute migraine attacks.

You may be familiar with the “triptan” class of medications which includes products like frovatriptan, rizatriptan, sumatriptan, zolmitriptan, and others. These medications work at 5-HT 1B and 5-HT 1D receptors so they have a slightly different mechanism of action than Reyvow®. One concern regarding triptans is that they can cause adverse effects to patients who have underlying cardiovascular disease. Since Reyvow® works through a different receptor subtype, the thought is that it will have a safer side effect profile regarding cardiovascular adverse effects. As the number of patients that cannot take triptans due to pre-existing cardiovascular disease is relatively small, and the fact that triptans are relatively inexpensive, Reyvow® therapy may not be as widely accepted as anticipated.

In 2018, Aimovig® was the first medication to be approved in a new class known as anti-CGRP antibodies or CGRP receptor antagonists.

Shortly after other agents such as, Ajovy® and Emgality® were approved. These three medications are administered via injectable, subcutaneous or intravenous routes depending on the specific product. They were all approved for use in the prevention of migraine attacks. Emgality® is also approved for use in the treatment of episodic cluster headaches.

In December 2019, the first oral CGRP receptor antagonist, Ubrelvy®, received FDA approval.

Unlike the other agents in this class, Ubrelvy® is approved for the treatment, not prevention of migraine headaches. The basis of approval for Ubrelvy® were clinical studies demonstrating efficacy, safety, and tolerability among patients that included those who had an inadequate response to triptan medications or those having a moderate to severe cardiovascular risk profile(2). Other potential oral CGRP therapies are also in the pipeline with potential approval in the next few years.

The approval of these medications offer new options in both the prevention and treatment of migraine headaches. These new medications could have costs in excess of $600+ per month, while established treatments are available generically at a fraction of that cost. Based on this, you could see various rates or acceptance from healthcare providers or strategies from payors regarding when and how these products should be used.

Thanks for stopping in and see you next month.

1,2 IPD Analytics, January 2020
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