A new migraine drug that can halve the length of attacks has been hailed as “the start of real change” in how the condition is treated. Erenumab, a laboratory-made antibody that blocks a neural brain pathway called CGRP, is the first drug in 20 years proven to prevent migraine attacks. Phase three trial data on nearly 1,000 patients showed that it typically cut between three and four “migraine days” per month. In half the patients treated, migraine duration was reduced at least by half.
Migraines are characterised by an intense, throbbing headache, sensitivity to light and noise, nausea, vomiting, low energy, and visual disturbances. Attacks can last anything from four to 72 hours. Each year more than 8.5 million people in the UK are thought to suffer migraines: more than the number affected by asthma, diabetes and epilepsy combined.
The condition is linked to depression and sick days caused by migraine are estimated to cost the UK economy more than £2bn per year. The trial, called Strive, compared patients taking erenumab for six months with others given a non-active placebo dummy drug.
The research revealed that by months four to six, at least a 50% reduction in mean migraine days per month was achieved for just over 43% of patients injected under the skin with 70-mg of erenumab each month, while half of patients injected with the higher dose of 140-mg had such results. However, those given a placebo also saw benefits, with 26.6% of participants in this group experiencing such a reduction.
Lead investigator Prof Peter Goadsby, from King’s College hospital, London, said: “Strive … represents an incredibly important step forward for migraine understanding and migraine treatment.”
The findings, reported in the New England Journal of Medicine, clearly showed that blocking the CGRP pathway could reduce the impact of migraine, he said. “The results of Strive represent a real transition for migraine patients from poorly understood, re-purposed treatments, to a specific migraine-designed therapy.”
Simon Evans, chief executive of the charity Migraine Action, said: “Migraine is too often trivialised as just a headache when, in reality, it can be a debilitating, chronic condition that can destroy lives. The effects can last for hours, even days in many cases.
“An option that can prevent migraine and that is well tolerated is therefore sorely needed, and we hope that this marks the start of real change in how this condition is treated and perceived.”
“Broadly speaking I think this is a very interesting study and I think it is a good step forward for the field and I think it is a good day for migraine sufferers,” said professor Zameel Cader, Director of the Oxford Headache Centre who was not involved in the research, pointing out that the results were on a par with currently available therapies for migraine.
“Placebo responses [in migraine studies] are quite high and I think that is partly due to the subjective nature of pain and because of the strong psychological effects that being treated have on that experience of pain and those symptoms,” he said, adding that injections generally result in an even stronger placebo effect than tablets.
Cader said that he too was looking at running trials using antibodies, and said he was excited about the approach since it might result in fewer side effects than current therapies, and would mean individuals would not have to remember to take a table every day.
“This is probably the first example of a migraine preventing drug that was rationally designed, rather than serendipitously found,” he added.