Search Results for: CGRP

5 April 2024

CGRP Medications: Better for Men, or Women?

James Discoveries & Stats, Information, Medications Cephalalgia, CGRP, CGRP receptor antagonist, gepant, Nurtec ODT, Rimegepant, ubrelvy, ubrogepant, zavegepant, Zavzpret 0

CGRP related medications for migraine are helping a lot of people. But if you’re going to try one, which medication should you start with? Does your sex make a difference?

Gepant drugs - a difference between women and men?

This is a question that is rarely asked or studied. That’s why a study review published in the medical journal Cephalalgia this year caught my attention. It was one of many studies on CGRP-related drugs – but in this case it was looking at the difference between men and women.

And in the case of one type of drugs, there was a difference – the “gepants” – that is, CGRP receptor inhibitors/antagonists. The specific drugs we’re talking about are:

ubrogepant (Ubrelvy)
rimegepant (Nurtec ODT)
zavegepant (Zavzpret)

Now, when these medications are used for acute migraine treatment – that is, when they’re taken to stop a migraine attack in progress – the evidence is positive. For women. However, for men, there is not yet enough evidence to show a clear benefit.

That doesn’t mean they won’t work for you – and maybe future studies will show a clearer benefit. But it could be that some of the CGRP medications simply work better in women.

It would be helpful to have further studies here, because if this difference stands up in further trials, it would be an easy way to pop certain types of medication higher on the list, because they’ll have a better chance of success, for you.

What about other CGRP medications? The meds for chronic migraine known as CGRP antibodies (the ones that end in “umab” – like fremanezumab or erenumab) seemed to work well for both sexes. Preventative CGRP medications also seemed to help both men and women, but the authors of the study would like to keep an eye out for differences in future studies.

Again, at this point this information shouldn’t stop you from trying CGRP medications. It may be information that can be added to the other info your doctor has in order to decide which to try first.

That being said, we look forward to future studies. Anytime we can make the path shorter to something that works to fight your migraine, we’re very interested.

It will also be very helpful in the future to find out why this is, so that we can better target migraine attacks.

To check out the study for yourself, click on Evaluation of outcomes of calcitonin gene-related peptide (CGRP)-targeting therapies for acute and preventive migraine treatment based on patient sex (pdf).

20 March 2023

Coming Soon: CGRP Antagonist Nasal Spray

James Medications, News CGRP, gepant, nasal spray, zavegepant, Zavzpret 0

This month the FDA in the USA approved the very first CGRP antagonist nasal spray, brand name Zavzpret. The drug is known as zavegepant. The new medication should be on the market as early as this July.

You may remember that the “gepant” medications, such as zavegepant, seem to be good abortives – taken during a migraine attack, they fight symptoms at the time (as opposed to preventatives, which of course prevent attacks).

People who would prefer to avoid injections and pills often go to nasal sprays. Many people like the speed of injections, but don’t like the injections themselves. And with migraine nausea, pills can be hard to take.

However, nasal sprays also tend to be very fast-acting. Zavzpret as a medication seems to be pretty fast-acting itself, which is good news for those who want to stop those migraine symptoms from escalating. The most recent study showed relief from pain as quickly as in 15 minutes.

Zavzpret is also very simple to use. It will probably be prescribed as one spray (into one nostril) of 10mg, once. That’s all.

Another advantage of Zaczpret is that there seem to be very few side effects. The most common (though still only a minority of patients experienced it) was a change in your taste – in other words, foods might taste a little funny. This was just temporary.

For more information on Zavzpret:

US FDA approves Pfizer’s nasal spray for migraine (Reuters)
Pfizer’s ZAVZPRET™ (zavegepant) Migraine Nasal Spray Receives FDA Approval (official press release)
Safety, tolerability, and efficacy of zavegepant 10 mg nasal spray for the acute treatment of migraine in the USA (recent clinical trial)

7 July 2022

Did You Quit Your CGRP Preventative Too Soon?

James Uncategorized allodynia, American Headache Society, CGRP, CGRP inhibitors, Deborah Friedman, ethics, Neurology Today, preventative, Thomas R. Collins, University of Texas Southwestern Medical Center 1

Typically, it seems to be a good idea to try any new treatment for three months. But a new study from Italy is suggesting that some patients may be quitting certain treatments too soon.

In this case, we’re talking about CGRP inhibitors that are used as migraine preventatives.

The study was presented at last month’s annual American Headache Society meeting. The study followed patients who were taking anti-CGRP medication for 48 weeks (about 11 months). The overwhelming majority of patients did indeed respond to the medication within 12 weeks. But depending on the medication, between 7.6% and 15.5% responded in weeks 13-48, the median time of response for the “late responders” being 20 weeks, or about 4.5 months.

Studies like this, though preliminary, raise some interesting issues. Dr. Deborah Friedman (from the University of Texas Southwestern Medical Center), quoted in an article in Neurology Today, gives her response to some of the online chatter that’s been happening:

There are colleagues of mine who said anybody who would keep somebody on a medication that didn’t work longer than three months, it’s unethical. Well, I keep my patients on it for four to six months and that’s what we did with Botox, because I’ve seen people respond late.
Dr. Deborah Friedman

Unethical? Why unethical?

Think about it. Even if there are a few people who may respond late, your chances of responding to the medication do significantly drop after 12 weeks. So if every patient is now put on a trial of 20 weeks or more (some are suggesting 6 months to a year), the drug company selling the product certainly benefits. The insurance company may not be so sure. And most of the people taking the medication for those extra weeks will never benefit from it, and so are only dealing with any side effects with no benefit at all. That’s the cold number crunching.

But the fact remains that some patients may be missing out because they’re only trying the medication for 12 weeks.

All right then, is there a way we could identify those patients – the ones that will benefit eventually – thus improving the odds?

The study has perhaps started to point the way. The researchers did note some tendencies among the late responders:

More likely to have a higher average body mass index
Slightly less likely to have one-sided pain with allodynia (more on this below)

Of course, this works both ways. If you have one-sided pain with allodynia, you may be a little more likely to benefit from an anti-CGRP preventative. Because basically the late responders were simply a little more like the non-responders.

This is a long way from a way to identify which patients will respond late. But what the study does tell us is that we should be looking closer to find out how we can identify those patients – it shows us that there may be a way, eventually.

Right now, it’s probably best to have a good relationship with a specialist you trust, and let them help you decide if it’s worth it to try your medication (or other treatment) for longer. They know you best, and know your medical history.

To delve further into this topic, check out the article at Neurology Today by Thomas R. Collins: Late Migraine Responses Seen for Anti-CGRP Therapy

Also the National Headache Foundation has put out a video on the optimistic side, explaining this study:

22 October 2020

What Is Surprising Us About The New CGRP Preventatives?

James Discoveries & Stats, Medications, News Aimovig, Ajovy, CGRP inhibitors, Emgality, migraine preventative, Reynaud syndrome, The American Journal of Managed Care, VYEPTI 0

Can you believe it? It was in the spring of 2018 that Aimovig (erenumab) was approved in the USA. My! Time flies!

Really, all the CGRP related drugs are still extremely new, when it comes to prescription drugs for migraine. Long term trials are still a future hope. And we’re just starting to guess at some trends that we may be seeing from patients.

But what are some of the trends we’re seeing? Let’s take a moment to talk about them, and you can comment if you’ve had a similar of very different experience.

(1) For many, these drugs are working better than expected!

First, the (very) good news. For many patients, these CGRP inhibitors are working better than the clinical trials even led us to believe.

As drug companies rush to market new migraine drugs, we expect to see headlines that use phrases such as “life-changing!”. But in the case of drugs like Avojy and Aimovig, this does seem to be the case with many patients – a very significant improvement in their symptoms.

And these are not always “just any” patient. These are patients who have not had a lot of success with other medications.

So there are good reasons to have a lot of hope that these new drugs will help many more people around the world in the next few years.

(2) Sometimes these drugs are less effective after a while.

This is a biggie. Reports are coming in that, for many patients, the benefits tend to “wear off” after a while.

Will switching to another CGRP preventative help? It’s very possible, and it’s not at all a surprise that you may need to try more than one before you find the right fit.

But this is one that researchers are going to pay a lot of attention to in the next few years. Which patients are having this issue, and why? Will some CGRP preventatives work better than others? Even if they’re not as beneficial as they were in the first few weeks, do they still provide significant benefit? What’s your experience?

(3) Side Effects

Any surprises with side effects? Side effects are not a huge problem for many patients, but it is starting to sound like constipation is an issue for some, especially with Aimovig (and in this case, switching may provide significant benefit). It seems that it may be more likely to make constipation issues worse if you already have a pre-existing condition.

In a recent discussion published in The American Journal of Managed Care, two neurologists pointed out some of the other side effects they’re seeing – “. . . a worsening of Reynaud syndrome, fatigue, hair loss, sexual dysfunction, and in women, some reports of irregular menstrual periods.”

Again, discussing side effects shouldn’t make it sound like patients are running away from these medications in droves because they’re all having major problems. Side effects may be rare, but we have to keep an eye on them because certain patients may be more prone to certain side effects than others.

If you’ve been taking a new preventative, such as Vyepti, Aimovig, Ajovy, or Emgality, how long have you been on it? What has your experience been? Anything you might share could be a help for our community.

10 September 2020

CGRP Inhibitor – but, I hate injections!

James Discoveries & Stats, Medications AbbVie, Allergan, atogepant, CGRP, gepant, migraine, preventative medication 0

CGRP Inhibitors, as preventives, have a lot of advantages. Sure, they may be injections, but they’re not taken every day like most preventatives for migraine.

I mean, in the case of Ajovy, you’re looking at an injection every three months.

But I know, some of you are saying – seriously, I don’t care how often it is. I don’t do injections!

You might want to keep an eye on a new preventative that may come out in 2021 – atogepant.

Now if you remember our discussion of different types of “CGRP drugs”, you’ll recall that the “gepant” drugs are generally being marketed for acute treatment – to take once a migraine attack has already started. But this one, taken orally, is being tested for prevention.

Part of the phase 2 trial was published online in August. 825 patients received atogepant, but they were divided up to receive varying doses – 10, 30 or 60mg once or twice a day. 5% or less experienced nausea or fatigue with certain doses – that number may be lessened significantly once we figure out which dose is best. But overall, there were no serious side effects, and over 12 weeks the patients saw a significant decrease in their days with migraine symptoms.

Phase 3 results are already being reported as well, and results look similar. Patients got back several days each month – several more migraine-free days. A slightly better result seems to come with the higher dosages.

Although this will be a once or twice a day dose, it’s oral – no injections! So keep your eye on this one.

For more on the study, see Safety, tolerability, and efficacy of orally administered atogepant for the prevention of episodic migraine in adults: a double-blind, randomised phase 2b/3 trial. For more history, check out Allergan: atogepant. (Note that Allergan is now owned by AbbVie, so don’t get confused.)