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New preventive treatments for migraine

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2507 (Published 13 June 2018) Cite this as: BMJ 2018;361:k2507
  1. Rebecca Burch, assistant professor of neurology1,
  2. Melissa Rayhill, assistant professor of neurology2
  1. 1Harvard Medical School Boston, Massachusetts, USA
  2. 2Jacobs School of Medicine and Biomedical Sciences State University of New York, Buffalo, New York, USA
  3. Correspondence to: R Burch rburch@bwh.harvard.edu

High prices put promising monoclonal antibodies out of reach for many patients

What is a day without migraine worth? Drug companies, payers, and patients are wrestling with this question as new treatments for migraine are developed and brought to market. Monoclonal antibodies to calcitonin gene related peptide or its receptor (CGRP mAbs) are a novel class of preventive treatment aimed at reducing the frequency of episodic migraine, chronic migraine, or cluster headache.

CGRP is a widely distributed vasodilatory neuropeptide that is involved in migraine pathophysiology. Four antibodies to CGRP or its receptor have been developed. Erenumab was approved by the US Food and Drug Administration on 17 May 2018, and a marketing application is under review by the European Medicines Agency. Galcanezumb and fremanezumab are under FDA review; eptinezumab’s licensing application has yet to be submitted to the FDA.

This new class of drugs is a welcome development for the estimated one billion people worldwide who have this chronic, disabling illness.1 Patients with infrequent migraine often manage headaches with symptom relieving drugs such as triptans. When headaches …

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