Migraine Sessions at CONy 2019
Continuing our coverage of CONy 2019, we are reporting on two debates supported by Teva in the field of diagnosis and treatment of migraine.
The first debate, hosted by Dr. Christian Lampl (Headache Medical Centre Linz, Austria), explored the question whether monoclonal antibodies (mAbs) to calcitonin gene-related peptide (CGRP) will become first-line treatment not only for migraine, but also for episodic cluster headache. Dr. Lars Edvinsson (Lund University Hospital, Sweden)—who discovered CGRP and established its link to the trigeminovascular system implicated in migraine in the early 1980’s—supported the view that anti-CGRP mAbs had the potential to become first-line agents in the treatment of both of these headache types. Dr. Edvinsson emphasized the fact that most traditional prophylactic drugs—e.g. beta-blockers, anti-depressants, anti-epileptics, and botulinum toxin—were originally developed for other indications. As a result of their lack of specificity to migraine, their use is often accompanied by adverse events that lead to poor patient compliance beyond 1 year.1 In contrast, Dr. Edvinsson presented anti-CGRP mAbs as agents specifically designed to target the migraine pain pathways. The favorable safety and tolerability of this drug class also offers the hope of improved patient compliance.
In the other corner, Dr. José Miguel Laínez (Universidad Católica de Valencia, Spain) argued that failure of traditional preventive treatments for migraine and cluster headache often results from lack of optimization of the treatment regimens. In this context, Dr. Laínez expressed that anti-CGRP mAbs would unlikely become first-line agents in these indications as long as current cost-effective agents are not used as part as individualized regimens to increase patient compliance. From a clinical evidence point of view, Dr. Laínez presented studies that showed similar benefits with anti-CGRP mAbs vs. traditional preventive agents in episodic migraine.2 In chronic migraine, anti-CGRPs failed to demonstrate superiority vs. topiramate or botulinum toxin.3 At the end of the debate, the audience leaned towards Dr. Laínez’ skepticism, but both sides agreed that the place of anti-CGRP mAbs in the treatment algorithm will be determined as more clinical evidence is produced in larger, longer-term randomized controlled trials.
Look out for upcoming highlights of the second Teva-supported debate at CONy 2019 on the topic of: “Are migraine with aura and without aura the same disease?”
Hepp Z, et al. Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia. 2015;35:478-88.
Hou M, et al. The effect and safety of monoclonal antibodies to calcitonin gene-related peptide and its receptor on migraine: a systematic review and meta-analysis. J Headache Pain. 2017;18:42. doi: 10.1186/s10194-017-0750-1.
Dodick DW, et al. Assessing clinically meaningful treatment effects in controlled trials: chronic migraine as an example. J Pain. 2015;16:164-75.