Allergan

10 September 2020

CGRP Inhibitor – but, I hate injections!

James Discoveries & Stats, Medications 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.)

8 June 2020

Should Botox Treatment be more “Standardized”?

James Discoveries & Stats, Medications, Treatments 0

Botox, generic name onabotulinumtoxinA, has become a common preventative treatment for migraine. But as we have noted before, you may get a different treatment depending on which doctor you go to.

During the last weeks of 2019, an anonymous questionnaire was sent to headache doctors to see just how they were using Botox, and the results might surprise you. But first, a little background.

A protocol has emerged to attempt to standardize Botox treatment, known as the PREEMPT protocol (named after Botox clinical trials). Allergan, the company that makes Botox, promotes this protocol as you can see here:

So there’s no doubt that Allergan wants doctors to use this protocol. But what did the study show?

Units? About 63% didn’t follow the protocol. “Proven sites”? Almost 58% didn’t follow the protocol. And 70% changed the injection sites. In fact, 77.5% of doctors said simply that they did not always follow the PREEMPT Paradigm.

Why not?

Going only by the abstract, the researchers explained: “The main reported reasons for changes in number, dose, and location of injections included adapting to the patients’ pain, anatomy, and preferences.”

That’s not really very specific, but the changes had to do with both doctor’s and patient’s “preferences”.

It should be noted that although some of these doctors were fairly new when it came to this treatment, many were quite experienced. In fact, 71.4% had more than three years’ experience.

The fact of the matter is that onabotulinumtoxinA research is moving on. Not just clinical trials, but also in the experience of the doctors providing the treatment. There is still a lot that we have to learn about Botox treatment – why does it work better for some patients than others? Could it be that PREEMPT is not the ideal for everyone?

Here you might find helpful some of the more recent articles on Botox treatment:

So the “why not” question is very important. If PREEMPT is the best treatment overall for migraine patients, that doesn’t mean that it’s the best for you. However, if it has the best evidence at the moment, it is a good starting place for most people. There’s a reason why Allergan is promoting this protocol.

But we should be careful to rule out the clinical experience of doctors, and the ongoing studies. What you should do is talk to your doctor and understand why she isn’t following PREEMPT in your case. She may have very good reasons. But it’s up to you to ask and get the answers you need before you start treatment.

Is your doctor adapting to “your anatomy”? Is your doctor simply not aware of PREEMPT? Has experience changed the way your doctor uses Botox for migraine? Ask!

The important message here from this study – be aware that Botox treatment is not standardized. Do your research and be aware of what your doctor is offering.

For more on this study:

7 December 2018

In the USA? Enter to win $100. (And something for everyone.)

James News, Resources 0

Everybody likes free things – this is something free, plus the chance to win something else free.

First, and this is for every human with internet access, not just those in the USA, the National Headache Foundation and Med-IQ (with a grant from Allergan, Inc.) have put up a website which might be useful to you.

It’s called “Living Well With Migraines“. (Not to be confused with the book, “Living Well with Migraine Disease and Headaches“, which is also useful.)

The site gives a quick introduction to migraine and living with it in a series of short articles. They do give a useful overview, though they are at times pretty simplistic. There are also some practical tools – tips for talking with your boss about migraine, a tip sheet for prescription coverage, and an overview of a few migraine apps, for example.

Some of the info will be USA-specific, but a lot of it will be useful to anyone.

Now, we want some winners! Yes, you can win a $100 American Express gift card. In fact, three will be given away. All you have to do is fill out a survey – it just takes a couple of minutes. You will have to check around the website first, though, because the questions are about your response to the site itself.

So go visit the site now, check it out, and fill in the survey. And I hope that all three winners are readers of Headache and Migraine News!

Oh, you’d better hurry. You need to fill it in before the 18th of December 2018.

7 October 2016

FitBit and Migraine

James News, Tips 0

The easier it becomes to track information, the more we want to do it. Although some people prefer to avoid the hassle, there are a growing number who are tracking as much health information as possible using their smart phone, and sometimes an additional device such as FitBit.

Apps such as Curelator and Migraine Buddy have helped many migraine patients track detailed information. It’s not that we want to look back and see how painful life has been over the past 30 days. It’s a way to find triggers, and possible solutions, to migraine attacks.

FitBit is one example of an “activity tracker”. It tracks things like how many calories you’re burning, how active you are in general, quality of sleep, the food you eat, heart rate, and more. As you may imagine, knowing and controlling your overall health can have a huge impact on your migraine symptoms. Here’s a promotional video for a recent incarnation of FitBit:

Using Power Sync for Fitbit, you can even sync FitBit data to your Apple Health data.

Kelley Nunn, blogger at My Migraine Brain, has used FitBit (read a bit about her tracking system here). Vera Sweeney, another blogger, has also written a little about using (and hiding!) FitBit.

The Mayo Clinic and Allergan will be working together with Second Opinion Health to test the use of FitBit and the Migraine Alert app (an upcoming app not yet available to the general public) to predict migraine attacks.

To find out more about the trial (which as I write it not yet open to participants), see Individualized Prediction of Migraine Attacks Using a Mobile Phone App and Fitbit (Migraine Alert).

You can request to try out Migraine Alert – just watch the video below for more information (it’s open to those with episodic migraine only at this point).

How about you? Do you use health tracking with your smart phone? Has it helped?

22 August 2016

Ubrogepant (another migraine drug in development)

James Medications, News 0

The development of the new CGRP class of drugs (actually, calcitonin gene-related peptide receptor antagonists) is continuing. Last year, Allergan gained the rights to two such medications from Merck – MK-1602 and MK-8031.

Merck ran into trouble several years ago with another one of it’s CGRP receptor antagonists, called MK-0974 and later Telcagepant, because of concerns about liver toxicity.

The two other drugs, however, belong to a different “chemical series”, and so far there has been no evidence of liver problems with these.

Farthest along is MK-1602, also known as ubrogepant. Ubrogepant is just about to enter phase 3 trials.

Back in June, ubrogepant was featured at a meeting of the American Headache Society. The report posted online said:

Researchers at Montefiore Medical Center and Albert Einstein College of Medicine conducted a randomized, placebo controlled, double-blind trial of the efficacy of ubrogepant in treating a single migraine attack. Patients who received the study medication reported a reduction in headache severity from severe or moderate to mild or none within two hours. Ubrogepant is free of known cardiovascular risk and may provide an important treatment option for individuals who suffer from cardiovascular disease. This trial supports ubrogepant’s effectiveness and provides further evidence that CGRP receptor antagonists are viable options for the acute treatment of migraine.

In other words, ubrogepant is another hopeful in the world of CGRP drugs for migraine.

Allergan is about to begin trials and will be looking for adults with episodic migraine who are interested in participating. At time of writing they are not yet recruiting participants. However, if you’re interested and want more information, visit the clinical trials page here: Efficacy, Safety, and Tolerability of Oral Ubrogepant in the Acute Treatment of Migraine