Monoclonal Antibodies and the Future of Migraine Treatment

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There are several areas of innovation related to managing migraines on the horizon.
There are several areas of innovation related to managing migraines on the horizon.

NATIONAL HARBOR – The next few years hold promise for “exciting” developments in treating migraines, according to several panelists who spoke on headache at the American Academy of Pain Medicine's 31st Annual  Meeting held here this weekend.

In their session for the American Headache Society, Richard B. Lipton, MD, of Albert Einstein College of Medicine, Andrew C. Charles, MD, of the University of California Los Angeles School of Medicine, and Peter J. Goadsby, MD, of the University of California San Francisco, discussed these developments and the future of managing migraine.

Goadsby said that the evolution of monoclonal antibody treatment represents an important development for treating migraines. He said there are several monocolonal antibodies being developed including: Amgent's AMG 334, Alder Biopharamceuticals' ALD 403, Arteaus Therapeutics, Labrys/Teva and Eli Lilly's LY2951742.

It is hoped that these monoclonal antibodies will target the calcitonin gene-related peptide (CGRP) pathway to actually prevent migraines by blocking CGRP activity. “If you get the mechanism right, you can actually stop an attack,” he said. 

Although it is likely to be years before these agents are approved, the fact that they are being studied represents an "exciting" era ahead for clinicians treating patients with migraine, Goadsby said. Currently, patients are treated with a range of medications from blood pressure to epilepsy medications.

Charles echoed those sentiments, noting that it is important for clinicians to familiarize themselves with the timeline of migraine, from initial yawning, neck, fatigue, mood change, light sensitivity, to nausea, visual and sensory symptoms, to the actual headache, and then to cutaneous allodynia.

Knowing this timeline presents an opportunity for the clinician to look at the full spectrum of the migraine and possibly take preventive steps during different phases of the migraine, with the optimal outcome of preventing the migraine, as may be the case with the monoclonal antibodies.

Lipton said that several exogenous factors have been looked at in terms of migraine progression, from episodic migraines to chronic migraines, including excess caffeine intake, head injuries, stressful life events, specific patterns of medication use, and comorbidities like obesity, depression and snoring.

Although the data are limited on intervening with these comorbidities to specifically reduce or prevent migraines, Lipton said that they can be part of a larger discussion with patients to encourage healthier lifestyles, which may have an effect on migraines and other health issues the patient may be experiencing. 

Reference

  1. Lipton RB, et al. "Headache - New Understanding and Evolving Management." Presented at: AAPM Annual Meeting. March 19-22, 2015; National Harbor, Maryland. 
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