WHAT IS ANTI-CGRP?

CGRP monoclonal antibody therapies are a new preventative treatment option for migraine. There are currently no existing treatments that eliminate migraine entirely, though these drugs have been shown in clinical trials to reduce migraine event frequency and severity in a moderate number of patients who experience frequent, disabling attacks. These medications are generally well tolerated, and are self-injected on a regular schedule (monthly).

HOW CAN WE HELP?

Ajovy (Fremanezumab) and Emgality (Galcanezumab) are new medications aimed to reduce the frequency and severity of migraines, in either episodic or chronic migraine.
These are monoclonal Antibody targeted against the receptor for or neurotransmitter of Calcitonin Gene Related Peptide (CGRP), which is involved in migraine headache generation.
It is a monthly SCI injection given by the person with an auto-injector at home. There can be redness and inflammation of the skin at the site of injection.

There are few if any short term side effects (nasal congestion; injection reactions). It was well tolerated in these trials. There are no known interactions or contraindications to using other medications inter-currently. Patients under 18 years of age, over 65 years of age, hemiplegic migraine, cluster headache, or recent Botox were excluded from the trial.

 This treatment has not gone head to head with other treatments but had steep, efficacy curves showing a relatively quick onset of reduction in migraines, in the group of responders. Overall, 40-50% of treated patients were >50% better in the randomised controlled trials. No treatment works for all migraine patients; nor does it completely cure the tendency to be able to have migraines.  

CGRP also resides in blood vessels, so the longer term effect of blocking this is not known. There have been over 2500 patients on this medication during the trials, with a group being on it for 3 years without any significant adverse events noted. There will be increasing knowledge through international migraine databases in upcoming months to years.  

It has been approved by Australian Therapeutics and Goods Administration (TGA), and is listed on the Pharmaceutical Benefits Scheme (PBS).

This means that it can be imported to and used in Australia but access is somewhat limited and needs to be further considered with your neurologist if you need to use it prior to PBS listing.

You should consider CGRP therapy if you:

• are moderately to severely disabled by frequent migraine attacks
• have not benefited from existing treatments
• have difficulty tolerating existing migraine treatments

 You should avoid these drugs if you:

• experience infrequent migraines and respond well to your existing treatment
• have cardiovascular disease, or are at high risk of heart disease or stroke
• are pregnant or trying to become pregnant
• suffer from severe constipation