After anti-CGRP Drugs to fight Migraine: anti-PAC 1?
Are anti-PAC1 drugs the next big thing for migraine treatment?
Based on the evidence we’ve seen so far, the new CGRP inhibitor drugs are likely to help many people with migraine. But for many they’re likely to be a big disappointment.
So amidst the ongoing media obsession with CGRP drugs, we have to ask – what’s next?
Of course, that’s probably the wrong question. Many branches of research are going on at the same time, and new treatments are constantly being tested. So what is special about this one?
Hitting the “Target”
As our understanding of migraine has grown, researchers have tried to find more “targeted” treatments. In other words, treatments that only affect the body in ways that specifically fight the migraine attack.
The more “general” (less targeted) a medication is, the more likely it is that it will have side effects.
For example, if we know that a certain chemical is low and causing pain, we could raise the level of that chemical to normal. Of course for migraine, that would be a major over-simplification, but that’s an illustration of the direction we want to go.
So the a lot of the excitement over anti-CGRP is because they’re more “targeted”. But some researchers think that anti-PAC1 drugs may take us to the next level.
PACAP
Recently, pituitary adenylate cyclase-activating polypeptide (PACAP) has been linked with both migraine and cluster headache. Researchers believe that it is an important messenger transmitting pain signals.
The most common PACAP is PACAP38, important in the neurological functioning of the head and face. We know that adding PACAP38 to the body can actually induce headache symptoms.
PACAP38 binds the PAC1 receptor. So blocking of the PAC1 through a PAC1 receptor antagonist could stop the migraine or cluster in its tracks.
In fact, we’ve talked about PACAP before and its genetic connection to cluster.
Incidentally, this treatment could help with other conditions, such as posttraumatic stress disorder.
And so begins the research…
Alder BioPharmaceuticals is already showing interest in this approach with their program to develop ALD1910 to fight migraine. Amgen is also on the brandwagon, with AMG 301.
For more information, be sure to check out this helpful article from Dr. Song Guo from the Danish Headache Center: Breakthroughs in migraine treatment