Another new drug for migraine is likely on its way to Canada.
A completely new type of migraine preventive medication has been developed over the last ten years, one which uses antibodies to stop migraine attacks. These antibodies are similar to the ones that help you fight viruses, like the common cold, but they are made to attach to molecules that are important in producing migraine attacks. By stopping these molecules from working, they reduce the frequency of migraine attacks in many patients.
Four new antibody preventive treatments for migraine have been tested in research trials over the last six years. Two of these are already available in Canada. We have had erenumab (Aimovig) since August, 2018, and galcanezumab (Emgality) since October, 2019. A third one, fremanezumab (Ajovy), will likely be coming to Canada later this year. All of these are usually taken once a month by subcutaneous injection (an injection under the skin).
What is new now is that the fourth medication in this class, an antibody called eptinezumab (Vyepti) has just been approved by the FDA in the United States, and will likely be available to patients there by April, 2020. It will take longer for eptinezumab to come to Canada, but the company involved, Lundbeck Canada), will likely bring it to Canada within the next year.
Eptinezumab is similar to Emgality and Ajovy in that it attaches to a molecule called CGRP (calcitonin gene-related peptide) and inactivates it. It is different in that it is given intravenously. This intravenous injection only needs to be given every three months. It has very few side-effects; in clinical research studies, less than 2 % of patients stopped the medication because of side effects.
Like all previous migraine preventive medications, eptinezumab does not help everybody. In chronic migraine (patients with migraine and headache on 15 days a month or more) it reduced the headache days by 75% or more in 33 % of patients. It reduced headache days by 50 % or more in 57%. Another study in chronic migraine reported that 61% of patients had a reduction in headache days of 50% or more. As an intravenous medication, eptinezumab may be able to work very quickly. It has been shown to reduce the likelihood of a headache on the day after the injection.
References
1. Dodick DW et al, Eptinezumab for prevention of chronic migraine: A randomized phase 2b clinical trial. Cephalalgia 2019,:39: 1075–1085.
