Update on Treatment of Acute Migraine

Calcitonin gene–related peptide (CGRP) is a neuropeptide that has both cerebral arteriolar dilating and pain modulation properties.  Decreasing CGRP is thought to increase inhibitory mechanisms which decreases the occurrence of migraine headaches.  There has been a lot of excitement regarding CGRP antibodies that are being developed to prevent migraines. Erenumab is on track to become the first CGRP antibody to be approved in May.

But there is also research for new drugs to treat acute migraine headaches. The drugs are currently forecast to have NDAs submitted in 2019.  Two (rimegepant and ubrogepant) are small molecule CGRP receptor antagonists, also known as gepants. The third is from a new class of drugs to treat migraines that are selective 5-HT1F agonists.  These drugs are also known as ditans.  Ditans are similar to triptans, but are not vasoconstrictors. 

Rimegepant, a gepant, was studied in two Phase III trials with a total of 2,181 patients. 19% of acute migraine patients treated with rimegepant were pain free at 2 hours compared to 14% with placebo. 37% of rimegepant patients were free of their most bothersome symptom at 2 hours compared to 25% with placebo.  Another gepant, ubrogepant, also had trial results recently reported.  In a 1,327 patient, Phase III trial, 20% of patients with an acute migraine treated with ubrogepant were pain free at 2 hours compared to 12% with placebo. 38% of ubrogepant patients were free of their most bothersome symptom at 2 hours compared to 28% with placebo.  The third drug, a ditan called lasmiditan, had results from a trial announced last summer.  In the Phase III SPARTAN trial, 39% of patients with an acute migraine treated with lasmiditan were pain free at 2 hours compared to 21% with placebo. 49% of lasmiditan patients were free of their most bothersome symptom at 2 hours compared to 34% with placebo.

You can review up-to-date information on all migraine drugs with the Prescribe Right Pharmaceutical Pipeline Tracker.