Rimegepant

5 April 2024

CGRP Medications: Better for Men, or Women?

James Discoveries & Stats, Information, Medications 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).

14 July 2023

Migraine when you’re 60+ >> A few important observations

James Discoveries & Stats, Information, Treatments 0

A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.

It might be useful to get a quick overview of some of the report’s findings.

Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.

But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.

If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.

How is 60+ Migraine different?

Attacks may not be different, but they can change throughout life. For example, many older adults find that:

Their headache pain is now more often two-sided
They may be less sensitive to light and noise
They may experience fewer “cranial autonomic symptoms”, such as congestion or watery eyes during an attack
Sometimes the attacks are less severe
They may experience “stroke-like” symptoms for the first time, including visual aura, trouble speaking, or difficulty with movement

How is 60+ Migraine diagnosis different?

Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.

Cardiovascular issues in general are important to check as well.

The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.

It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.

How is 60+ Migraine treatment different?

Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).

CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.

However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.

Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.

If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.

Article: Migraine After 60: What You Need to Know
Report: Episodic Migraine and Older Adults

17 June 2021

Big News for Nurtec ODT (Rimegepant)

James Medications, News 0

Last month it was announced that the migraine medication Nurtec ODT was approved for the preventative treatment of episodic migraine in adults. This is big news – but you need to understand a little bit of background.

Nurtec ODT, or rimegepant, is one of the new medications that targets CGRP. There are a number of different treatments that are emerging related to CGRP (calcitonin gene-related peptide). And researchers have been investigating which treatments might be better for prevention, and which may be better to take to stop a migraine attack as it happens.

Rimegepant is in the “gepant” class (hence the last part of its name), a CGRP receptor antagonist. It has been noted for a while that the gepant drugs tend to work very quickly – excellent as an abortive drug to take during a migraine attack. And when Nurtec ODT hit the market, one of its selling-points was that it came as a a fast-acting orally disintegrating tablet – ODT.

But while these drugs have been shuffled down into either the “preventative” or “abortive” category, the question has remained – is it possible that some may be effective as both? In the case of rimegepant, researchers noticed that it tended to have a more sustained effect than some other CGRP related medications. So it seemed like a good candidate for a preventative.

And it seems that this is the case. This from the Biohaven Pharmaceuticals press release:

This new approval makes NURTEC ODT the first oral CGRP antagonist approved for the preventive treatment of migraine, and the only migraine medication approved as a dual therapy for both the acute and preventive treatment. NURTEC ODT is approved for acute treatment in all eligible adult patients with migraine, regardless of the number of monthly migraine days.
FDA Approves Biohaven’s NURTEC® ODT (rimegepant) for Prevention

For abortive use, the medication is taken as a 75mg dose. Because of the sustained effect, only one tablet is taken within 24 hours.

For preventative use, it’s the same – 75mg, once every other day.

Not only does Nurtec ODT have a good safety record, it will be very attractive for patients who are looking for a preventative, especially if they don’t like to take a number of pills every day. Of course, you do have to find a way to remember to take it every other day – but migraine patients do learn to be organized!

So this is big news. We’ll see if other CGRP related medications also cross the line from one type of medication to another. Meanwhile, many migraine patients who are experiencing a lot of migraine symptoms in a given month will be looking to see if Nurtec ODT is right for them.

For more information:

21 May 2020

Vazegepant: Migraine and COVID-19

James Medications, News 0

A new drug is being testing that may be used both for migraine – and COVID-19.

The drug is called vazegepant (BHV-3500). It’s one of the “gepant” medications that we’ve talked about before. Generally, they should make great abortive drugs because they work quickly, but they are slower coming to the market because of the testing that is needed.

Vazegepant comes from Biohaven, the makers of rimegepant – sold as Nurtec ODT. Rimegepant is an abortive, but it’s being tested as a preventative as well.

Vazegepant is soon to enter phase 3 of testing as a preventative for migraine, given as a nasal spray. Biohaven says this about the new medication:

Vazegepant (BHV-3500), the second product candidate in our CGRP platform, is a highly soluble small molecule CGRP receptor antagonist. It is also structurally distinct from rimegepant. The chemical properties of vazegepant make the product candidate potentially suitable for multiple routes of delivery, including nasal, subcutaneous, inhalation or oral administration.
Vazegepant

So, another “CGRP” related drug, but with some unique properties. And one of those unique properties may be the treatment of COVID-19. Specifically, the treatment of more severe cases.

On the 8th of April, the FDA gave approval for the trial to begin. The hope is that vazegepant may help stop a major complication of COVID-19. Dr. Donnie McGrath from Biohaven explains: “There is a solid scientific rationale supporting testing of small-molecule CGRP antagonists as a way to mitigate the neuro-immune consequences of respiratory viral infections like COVID-19.” [source]

The phase 2 trial is now recruiting in the USA. If you would like information, the trial information is available here, with contact information: Safety and Efficacy Trial of Vazegepant Intranasal for Hospitalized Patients With COVID-19 Requiring Supplemental Oxygen

3 April 2020

Introducing Nurtec for Migraine

James News 2

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.

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.