CGRP Update – February 2020
The following information is correct as of Monday the 25th of February 2020…
There are 2 main approaches for targeting CGRP in migraine: monoclonal antibodies given by injection to prevent attacks and small absorbable tablets for acute and preventative treatment. Medications act by either blocking a receptor called the calcitonin gene-related peptide receptor (CGRP-R), or binding to the substance (CGRP) and not allowing it to reach the nerve.
CGRP – What is it and what does it do?
- It’s a substance that is released in the trigeminal nerve
- It spikes during migraine
- CGRP dilates blood vessels
- Degrades mast cells (cells which control inflammation during allergic reactions)
- Creates an inflammatory fluid in the blood vessels
For more information see Prof. Peter Goadsby’s Interview from the European Academy of Neurology Congress 2016 on our website
There are several pharmaceutical companies involved in the manufacture of CGRP and other drugs. The main ones are; Amgen/Novartis Inc, Teva, Eli Lilly, Alder/Lundbeck, Allergan and Biohaven Pharmaceuticals.
Here are the names of some of the Anti-CGRP Medications which will hopefully enter the Irish market soon;
|CGRP Compound||Brand Name||Pharma Company||Administered||Preventative/Acute|
|Erenumab||Aimovig||Amgen/Novartis||Auto-injector once a month||Preventative|
|Fremanezumab||Ajovy||Teva||Subcutaneous injection once a month or quarterly||Preventative|
|Galcanezumab||Emgality||Eli Lilly||Subcutaneous injection once a month||Preventative|
|Eptinezumab||Alder/Lundbeck||Intravenous injection once every 3 months||Preventative|
- The Marketing Authorisation was granted in Ireland in the Summer 2018 and Novartis is currently awaiting the results of the Health Technology Assessment for the Irish licensing application. The Migraine Association wrote the supporting patient organisation document as part of this process.
- Erenumab was available on a managed access programme but this programme unfortunately closed to new patients in June 2019
- Teva’s version of anti-CGRP medication, Fremanezumab (Ajovy) became available on a ‘Free of Charge’ programme, which is similar to the managed access programme, from July 2019. New patients can only access Fremanezumab through their Neurologists, and only after meeting certain criteria, one of which is having tried and failed three or four other preventative medications.
- Teva is also awaiting the results of the Health Technology Assessment for the Irish licensing application. The Migraine Association wrote the supporting patient organisation document as part of this process.
- Lilly’s Galcanezumab is next, but we have no news as to its availability yet. There is the strong possibility that Galcanezumab will also be made available to treat those who suffer with Cluster Headache too, the only one of the new medications to say this!
- Lilly’s Lasmiditan (Reyvow) is not an anti-CGRP but the first of a new group of headache medicines that are called “ditans.” Just like a triptan, Lasmiditan can stop a migraine when taken at the appropriate time, but unlike a triptan, Lasmiditan does not have vasoconstricting properties and may be helpful for people for whom triptans are contraindicated due to cardiovascular problems.
Much of the information that is currently available in relation to these new anti-CGRP medications applies to the UK or the US, e.g. Both Erenumab and Fremanezumab have been passed by the Scottish Medicines consortium for use in migraine in Scotland with Erenumab passed only for people with chronic migraine and Fremanezumab for both chronic and episodic migraine, for patients who have failed to respond to 3 other preventatives.
For further information and updates, you can go to www.cgrpforum.org where you can sign up for a newsletter every few weeks.
Other than the information above, we have no details of if or when the medications will be available here. We will bring further updates as we learn more.