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CGRP Medications: Better for Men, or Women?

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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).

Coming Soon: CGRP Antagonist Nasal Spray

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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.

Zavzpret

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:

QULIPTA (Atogepant) Recent Reports

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It’s about time to have an update on QULIPTA, otherwise known as atogepant, a newer migraine preventative.

Atogepant (QULIPTA)

You may remember that we were talking about atogepant back in 2020. At a time when many medications were coming out as injections, atogepant was a bit of a breath of fresh air. A preventative, taken orally, and only taken once a day (10, 30 or 60mg), with or without food. Much more convenient even than many other oral preventatives.

Atogepant was approved by the FDA in 2021, but studies continue. QULIPTA came up at the June 2022 American Headache Society 64th Annual Scientific Meeting a number of times, and we’re learning more about it as it begins to be used more in the general population.

For example, it was found that some patients seem to lose weight when taking atogepant. It’s a minority, but still a significant number. Not only were patients less likely to gain weight, some actually lost weight taking the medication. Something to watch.

It was confirmed once again that you can take atogepant with or without food. The difference seems to be negligible.

It seems that although many patients find their symptoms diminishing in the first month of treatment, others do need to wait 2 or even 3 months before atogepant works for them. And so far, patients taking the preventative for a year seem to still benefit (we’ll keep watching this – remember, the medication is very new!).

A patient who took the COVID-19 mRNA vaccine experienced continuous migraine visual aura, and was successfully treated using atogepant. This may be a useful treatment for migraine symptoms after vaccination, another one to watch.

More studies have been done on the overall safety of QULIPTA. So far, the news is good – it seems to be generally safe. However, as with any medication, it is very important to tell your doctor about any supplements, medications, vitamins, and so on, that you may be taking. This may affect your dosage.

For more information about atogepant, visit the official QULIPTA site here.

CGRP Inhibitor – but, I hate injections!

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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.

No injections!

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.)

Introducing Nurtec for Migraine

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With all that’s going on in the world, it’s easy to miss the important migraine stories that may have a positive impact on treatment for years to come. One of those recent news stories was the approval of a new migraine drug, Nurtec.

Nurtec for migraine

We’ve talked about Nurtec before, under its generic name rimegepant. Nurtec was approved last month by the FDA for the acute (abortive) treatment of migraine.

Nurtec is not the first (and probably won’t be the last) “gepant” medication to be approved. We already know that one drug of the same class may work for you when another doesn’t. But what are Nurtec’s specific strengths?

Here’s what the makers of Nurtec say in their press release:

  • First and only calcitonin gene-related peptide (CGRP) receptor antagonist available in a fast-acting orally disintegrating tablet (ODT)
  • A single oral dose of NURTEC ODT 75 mg can provide fast pain relief and return patients to normal function within one hour, and deliver sustained efficacy that lasts up to 48 hours for many patients
  • 86 percent of patients treated with a single dose of NURTEC ODT did not use a migraine rescue medication within 24 hours

Well, it may be similar to what many migraine medications want to claim, but for Nurtec it’s speed and effectiveness. The fast-acting dissolving tablet does tend to be a help, and these drugs seem to work very quickly as it is. It is attractive to be able to take one tablet, and not need to take anything else.

It’s also a convenient drug because you don’t need to take it with water.

If you want to learn more, you can visit the official Nurtec website here. But Biohaven has kindly provided us with an info sheet, which you can download (pdf file) by clicking on the graphic below.

Nurtec infographic from Biohaven
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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
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