New Migraine Drug Approved: Four Things Health Execs Need to Know

A newly approved drug shows promise for people who have unsuccessfully tried to prevent migraine headaches with other treatments. Findings from a preliminary study of Aimovig (erenumab), the new drug, on 246 people who had episodic migraine were presented at the American Academy of Neurology’s (AAN) annual meeting in April.

“The people included in our study were considered more difficult to treat, meaning that up to four other preventative treatments hadn’t worked for them,” says study author Uwe Reuter, MD, medical director at the Charite-University Medicine Berlin in Germany. “Our study found that erenumab reduced the average number of monthly migraine headaches by more than 50% for nearly one-third of study participants.”

Those treated with Aimovig also had a greater average reduction in the number of days they had headaches and the number of days they needed to take drugs to stop migraines.

Lawrence C. Newman, MD, professor of neurology and director of the headache division at NYU Langone Health in New York, NY, who attended the AAN meeting and heard the presentation about the new drug, says there hasn’t been a new medication to treat migraines for 50 years. “The drugs we have don’t work for everyone and may cause significant side effects,” he says. “Because we don’t have a cure for migraines yet, and because no one medication works for everyone, new treatments are necessary for the 36 million people who suffer from migraines.”

Here are four things health execs should know about the new drug.

• The new drug works differently than other migraine medications.

Aimovig is a drug in a new class of medications called calcitonin gene receptor peptide (CGRP) monoclonal antibodies. CGRP is one of the neuropeptides that is released during a migraine and leads to pain, inflammation, and dilation of blood vessels.

It is a subcutaneous injection given once a month in one single injection dose. “Physicians don’t have to worry about adherence, since it’s only a once-per-month injection,” Newman says.

  2.   The medication is used to prevent migraines. Monoclonal antibodies are used to prevent migraine attacks; they are not meant for someone to take when they have signs of a migraine, such as sensitivity to light and sound, disturbed vision, nausea, and vomiting.

“This is the first treatment developed specifically for migraine prevention,” says Katherine S. Carroll, MD, neurologist, Northwestern Memorial Hospital, Chicago, Ill. “Prior to erenumab, medications used for other purposes (e.g., anti-hypertensive medications, anti-depressants, and anti-epileptics) were used because they were also found to be helpful in preventing migraines.”

Reuter points out that people who take the drug might still get acute migraines, and will need to take triptans (i.e., serotonin receptor agonists) to prevent them when they have signs of getting one. But they won’t need triptans as frequently.

  3.   The new drug has fewer side effects. The side effects include injection site irritation for a few hours or upper respiratory symptoms. “It doesn’t cause any cognitive effects, weight loss, or weight gain like some other migraine medications,” Newman says.

Typical migraine medications take about six weeks to exert efficacy. “Patients sometimes have to undergo weeks of trial and error until we determine the best dose of a medication to sustain effect, but migraine physicians should know within a week if this medication works for a patient,” he says.

  4.   The new drug will probably cost more.
The new drug will likely be more expensive than current medications. “So it probably won’t be a first line choice for everyone,” Reuter says.

Although this new treatment option may be quite costly, it could lower the overall costs for migraine treatment by preventing frequent emergency department visits and hospitalizations that patients with unmanageable migraines often have, Carroll says. “Improved migraine control leads to less time off work and less disability.” In addition, fewer migraines could lead to better overall mental health and less depression and anxiety-which are common comorbities in people who suffer from chronic migraine pain.

The drug received FDA approval May 17.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.