CGRP pathway monoclonal antibodies
The first preventive medication dedicated to treating migraine
These are the newest preventive medicines specifically developed and licenced for the treatment of migraine. Most of the current preventive medicines used to treat migraine have been developed for other conditions. This is therefore an exciting development for migraine sufferers.
How they work
Migraine is a brain disorder. During a migraine attack the cerebral nerves and blood vessels release substances including Calcitonin Gene-Related Peptide (CGRP). CGRP is a neuropeptide and has been implicated in different pain processes, including migraine. CGRP also functions as a vasodilator — that is, it relaxes blood vessels.
Research suggests that these substances are released during a migraine attack and play a significant role in developing and sustaining migraine.
The four CGRP monoclonal antibody (mAbs) treatments
|CGRP compounds||Erenumab Aimovig (Novartis/Amgen)||Fremanezumab Ajovy (Teva)
|Galcanezumab Emgality (Eli Lilly)||Eptinezumab (Lundbeck)|
|Availability in the UK||Privately – not throughout NHS (available within NHS Scotland for chronic migraine)||Approved for use within the NHS in England, Wales and Scotland for chronic migraine.
Available within NHS Scotland for episodic migraine.
|Privately – not on NHS||Due to be submitted for approval to be available in the UK|
|How it is administered||Subcutaneous injection once per month||Subcutaneous injection once per month or every three months||Subcutaneous injection once per month||Intravenous injection once every three months|
These four new compounds have been developed to either inactivate the CGRP molecule by binding to it or to block its receptor, to prevent migraine developing. Recent research conducted in thousands of people with migraine has demonstrated that these compounds are safe and effective in reducing migraine attacks and headache days.
None of the compounds are to be taken by mouth. This has the advantage of bypassing the gut, with possibly fewer side effects and the convenience of treating monthly or less. Three of these compounds are designed to be given by subcutaneous injection (just under the skin), once per month. The fourth, Eptinezumab will be given intravenously (into a vein by infusion), once every three months. The main side effects noted in the studies were associated injection site reactions.
Access to treatment
As with all new treatments, NICE (National Institute for Health and Care Excellence) and SMC (Scottish Medicines Consortium) will consider the evidence and affordability criteria to determine NHS patient access.
In England & Wales fremanezumab (Ajovy) is available for people with chronic migraine who have failed to respond to three preventive treatments.
In Scotland fremanezumab (Ajovy) is available for chronic migraine patients who have failed to respond to three preventive treatments. It is also available for people with episodic migraine who have failed three preventive treatments. Erenumab (Aimovig) is also available in Scotland for people with chronic migraine who have failed three preventive treatments.
If you are struggling to manage your migraine and think you may benefit from this or another treatment, you should see your GP for a review and possible referral for treatment.