Are new migraine preventive therapies meeting unmet needs?

Why are there unmet needs in the management of migraine?

Preventive medications used in the past have not been designed to treat migraine specifically, explained Professor Gregor Brössner, Innsbruck, Austria. They include beta-blockers, tricyclic antidepressants, anti-epileptics, and onabotulinumtoxinA.¹

As a result, many patients have a history of discontinuing one or more preventive medications due to a lack of efficacy or adverse events and do not use preventive therapy.¹

Many patients have discontinued preventive medications in the past due to a lack of efficacy or adverse events

Patients therefore use acute medications for their migraine episodes, but for some, this can lead to:

• Medication overuse, as they increase the quantity and frequency of their acute medication to control their symptoms²

Use of acute medications to control migraine can lead to medication overuse headache

• Medication-overuse headache (MOH),² which is defined as a headache occurring on 15 days/month in a patient with a pre-existing headache disorder associated with regular medication overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache³

The worldwide prevalence of MOH is estimated to be at least 1–2% of the general population.⁴

Are new migraine preventive therapies addressing unmet needs?

The unmet needs in the management of migraine were identified by Dr Patricia Pozo-Rosich, Barcelona, Spain, as improved efficacy, tolerability, adherence, and quality of life, and lowered total pain burden.

Anti-CGRP mAbs exhibit a more favorable benefit-risk ratio than established migraine preventives

Evidence is now confirming that anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (anti-CGRP mAb) are effectively addressing these needs, she said, as demonstrated by:

• A 2021 systematic review and likelihood to help or harm analysis, which concluded that anti-CGRP mAbs exhibit a more favorable benefit-risk ratio than established treatments for episodic and chronic migraine⁵
• High adherence (defined by mean medication possession ratio and proportion of days covered over 6 months, which were 0.86 and 0.71, respectively) and persistence with therapy (defined as average length of therapy until first discontinuation, which was 128 days)⁶

Anti-CGRP mAb reduces the frequency, severity, and duration of migraine episodes

• Improved quality of life based on improvements in the Patient Global Impression of Improvement—79.2% (95% confidence interval 75.7–82.4%) of patients who had been treated with anti-CGRP mAb within the previous 3 months reported their migraine condition as better since starting the anti-CGRP mAb⁷
• Lower migraine total pain burden (ie, the frequency, severity, and duration of migraine episodes)⁸

This satellite symposium was funded by Eli Lilly.