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Bhardwaj R, Morris B, Matschke K, Bertz R, Croop R, Liu J. A Drug-Drug Interaction Study to Evaluate the Impact of Rimegepant on OCT2- and MATE1-Mediated Transport of Metformin in Healthy Participants. Clin Pharmacol Drug Dev 2024; 13:465-473. [PMID: 38174905 DOI: 10.1002/cpdd.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
Rimegepant is a calcitonin gene-related peptide receptor antagonist approved for migraine treatment. This phase 1, open-label, single-center, fixed-sequence study evaluated the effect of rimegepant on the pharmacokinetics (PK) of metformin. Twenty-eight healthy participants received metformin 500 mg twice daily from Days 1 to 4 and Days 7 to 10, and once daily on Days 5 and 11. Rimegepant, 75 mg tablet, was administered once daily from Days 9 to 12. At pre-specified time points, plasma metformin concentration, serum glucose levels, and safety and tolerability were evaluated. A 16% increase in the area under the plasma metformin concentration-time curve (AUC) for 1 dosing interval (AUC0-τ,ss), a statistically insignificant increase in maximum and minimum steady-state metformin concentration (Cmax,ss and Cmin,ss), and a decrease in metformin renal clearance were observed on Day 11 following metformin-rimegepant coadministration compared with metformin alone; however, the changes were not clinically relevant. Additionally, coadministration of rimegepant with metformin did not induce clinically meaningful change in the maximum observed glucose concentration (Gmax) or AUCgluc compared with metformin alone. Overall, rimegepant and metformin coadministration did not result in clinically relevant changes in metformin PK, renal clearance, or the antihyperglycemic effects of metformin. Rimegepant is considered safe for use with metformin.
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Affiliation(s)
| | - Beth Morris
- Biohaven Pharmaceuticals Inc., New Haven, CT, USA
| | | | | | - Robert Croop
- Biohaven Pharmaceuticals Inc., New Haven, CT, USA
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Reuter U, Goadsby PJ, Ferrari MD, Da Silva Lima GP, Mondal S, Kalim J, Hasan F, Wen S, Arkuszewski M, Pandhi S, Stites T, Lanteri-Minet M. Efficacy and Safety of Erenumab in Participants With Episodic Migraine in Whom 2-4 Prior Preventive Treatments Had Failed: LIBERTY 3-Year Study. Neurology 2024; 102:e209349. [PMID: 38669638 DOI: 10.1212/wnl.0000000000209349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The LIBERTY study assessed the efficacy and safety of erenumab in participants with episodic migraine (EM) and 2-4 prior preventive treatment failures. The results have been presented after 3 years of erenumab exposure in its open-label extension phase (OLEP). METHODS Participants completing the 12-week double-blind treatment phase (DBTP) of the LIBERTY study could enter the OLEP and receive 140 mg of erenumab once monthly for 3 years. The main outcomes included the proportion of participants achieving ≥50% reduction in monthly migraine days (MMDs), the mean MMD change from baseline, and tolerability and safety. RESULTS Overall, 240/246 (97.6%) participants entered the OLEP and 168/240 (70.0%) completed the study (85/118 continuing erenumab [n = 1 lost during follow-up]; 83/122 switching from placebo [n = 2 lost during follow-up]). In the overall population, 79/151 participants (52.3%) with valid data points achieved ≥50% reduction in MMDs at week 168 (i.e., responders). In the continuous erenumab group, 35/117 participants (29.9%) were ≥50% responders at week 12 of the DBTP and 26/35 (74.3%) remained ≥50% responders in at least half of OLEP visits. Of the 82/117 participants (70.1%) not achieving responder status at week 12 in the continuous erenumab group, 17/82 (20.7%) converted to ≥50% responders in at least half of OLEP visits. Of 103/120 participants (85.8%) not achieving responder status at week 12 in the placebo-erenumab group, 42/103 (40.8%) converted to ≥50% responders in at least half of OLEP visits after switching to erenumab. Overall, the mean (SD) MMD change from baseline showed sustained improvement over 3 years (-4.4 [3.9] days at week 168). The most common treatment-emergent AEs (per 100 person-years) were nasopharyngitis (28.8), influenza (7.5), and back pain (5.8). Overall, 9.6% (3.9 per 100 person-years) and 6.7% (2.7 per 100 person-years) of participants reported events of treatment-emergent hypertension and constipation, respectively. The safety and tolerability profile remained consistent with earlier studies. DISCUSSION Erenumab (140 mg) showed sustained efficacy over 3 years in participants with EM and 2-4 prior preventive treatment failures. No new safety signals were observed. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03096834.
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Affiliation(s)
- Uwe Reuter
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Peter J Goadsby
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Michel D Ferrari
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Gabriel Paiva Da Silva Lima
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Subhayan Mondal
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Jawed Kalim
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Fatima Hasan
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Shihua Wen
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Michal Arkuszewski
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Shaloo Pandhi
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Tracy Stites
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
| | - Michel Lanteri-Minet
- From the Department of Neurology (U.R.), Charité Universitätsmedizin Berlin; Universitätsmedizin Greifswald (U.R.), Germany; NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (M.D.F.), Leiden University Medical Center, the Netherlands; Amgen Inc. (G.P.D.S.L.), Thousand Oaks, CA; Novartis Healthcare Pvt. Ltd. (S.M., J.K., F.H.), Hyderabad, India; Novartis Pharmaceutical Corporation (S.W., T.S.), East Hanover, NJ; Novartis Pharma AG (M.A., S.P.), Basel, Switzerland; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Université Côte d'Azur, France; and INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France
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Croop R, Berman G, Kudrow D, Mullin K, Thiry A, Lovegren M, L'Italien G, Lipton RB. A multicenter, open-label long-term safety study of rimegepant for the acute treatment of migraine. Cephalalgia 2024; 44:3331024241232944. [PMID: 38659334 DOI: 10.1177/03331024241232944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The present study evaluated the long-term safety and tolerability of rimegepant, an orally administered small molecule calcitonin gene-related peptide receptor antagonist, in people with migraine. METHODS This multicenter, long-term, open-label safety study included adults (≥18 years) with ≥1 year history of migraine who were sequentially enrolled into three groups: participants in the first two groups had either 2-8 or 9-14 moderate to severe migraine attacks per month by history and treated as needed (pro re nata [PRN]) with one rimegepant 75 mg oral tablet up to once per calendar day for 52 weeks (PRN 2-8 and PRN 9-14); a third group, included to collect safety data during higher-frequency dosing, had 4-14 moderate to severe migraine attacks per month by history and who took one rimegepant tablet every other day as scheduled dosing plus PRN dosing of one rimegepant tablet for migraine attacks of any severity on nonscheduled dosing days for 12 weeks (every other day (EOD) + PRN). RESULTS Overall, 1800 participants self-administered rimegepant (PRN 2-8: n = 1033; PRN 9-14: n = 481; EOD + PRN: n = 286). The most common on-treatment adverse events (AEs) were upper respiratory tract infection (8.8%), nasopharyngitis (6.8%) and sinusitis (5.1%). Most AEs were mild or moderate and considered unrelated to rimegepant. Serious AEs considered possibly (n = 1) or unlikely (n = 9) related to rimegepant were reported in ten (0.6%) participants. No signal of drug-induced liver injury because of rimegepant was identified. CONCLUSIONS Rimegepant 75 mg up to once per day as EOD + PRN for 12 weeks or PRN for up to 52 weeks was safe and well tolerated. No signal of hepatotoxicity, potential drug abuse, or medication-overuse headache was identified.Trial registration: Clinicaltrials.gov: NCT03266588.
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Affiliation(s)
| | - Gary Berman
- Clinical Research Institute, Inc., Minneapolis, MN, USA
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Kathleen Mullin
- New England Institute for Neurology and Headache, Stamford, CT, USA
| | | | | | | | - Richard B Lipton
- Albert Einstein College of Medicine and the Montefiore Headache Center, Bronx, NY, USA
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Singh R, Kumar A, Lather V, Sharma R, Pandita D. Identification of novel signal of Raynaud's phenomenon with Calcitonin Gene-Related Peptide(CGRP) antagonists using data mining algorithms and network pharmacological approaches. Expert Opin Drug Saf 2024; 23:231-238. [PMID: 37594041 DOI: 10.1080/14740338.2023.2248877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) antagonists are recently approved for the treatment of migraine. AIM The main aim of the current study was to find out the association of CGRP antagonists with RP using data mining algorithms integrated with network pharmacological approaches. RESEARCH DESIGN AND METHODS The individual case safety reports were extracted using OpenVigil2.1-MedDRA-V17 (2004Q1-2022Q3), the United States Adverse Event Reporting System (US FAERS). The data mining algorithms i.e. reporting odds ratio (ROR) with 95% confidence and proportionality reporting ratio (PRR) with associated chi-square value were calculated along with a minimum of three ICSRs to identify the signal. Further, the network was constructed using Cytoscape 3.7.2. Finally, molecular docking was performed using Glide, Schrodinger Inc. RESULTS The PRR ≥2 with a linked chi-square value ≥4, add up of co-occurrence ≥3, and a lower limit of 95% confidence interval of ROR exceeding 2 indicates a positive signal of RP. Further, the network pharmacological and molecular docking results have shown the involvement of insulin-like growth factor 1-receptor (IGF1R) pathways. CONCLUSION The RP is recognized as a novel signal with all CGRP antagonists.
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Affiliation(s)
- Rima Singh
- Department of Pharmacology, DelhiPharmaceutical Sciences and Research University New Delhi, India
| | - Anoop Kumar
- Department of Pharmacology, DelhiPharmaceutical Sciences and Research University New Delhi, India
| | - Viney Lather
- Department of Pharmaceutical Chemistry, Amity University Noida, India
| | - Ruchika Sharma
- Centre for Precision Medicine and Pharmacy, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - Deepti Pandita
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India
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Takizawa T, Ihara K, Uno S, Ohtani S, Watanabe N, Imai N, Nakahara J, Hori S, Garcia-Azorin D, Martelletti P. Metabolic and toxicological considerations regarding CGRP mAbs and CGRP antagonists to treat migraine in COVID-19 patients: a narrative review. Expert Opin Drug Metab Toxicol 2023; 19:951-967. [PMID: 37925645 DOI: 10.1080/17425255.2023.2280221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Migraine pharmacological therapies targeting calcitonin gene-related peptide (CGRP), including monoclonal antibodies and gepants, have shown clinical effect and optimal tolerability. Interactions between treatments of COVID-19 and CGRP-related drugs have not been reviewed. AREAS COVERED An overview of CGRP, a description of the characteristics of each CGRP-related drug and its response predictors, COVID-19 and its treatment, the interactions between CGRP-related drugs and COVID-19 treatment, COVID-19 and vaccination-induced headache, and the neurological consequences of Covid-19. EXPERT OPINION Clinicians should be careful about using gepants for COVID-19 patients, due to the potential drug interactions with drugs metabolized via CYP3A4 cytochrome. In particular, COVID-19 treatment (especially nirmatrelvir packaged with ritonavir, as Paxlovid) should be considered cautiously. It is advisable to stop or adjust the dose (10 mg atogepant when used for episodic migraine) of gepants when using Paxlovid (except for zavegepant). CGRP moncolconal antibodies (CGRP-mAbs) do not have drug - drug interactions, but a few days' interval between a COVID-19 vaccination and the use of CGRP mAbs is recommended to allow the accurate identification of the possible adverse effects, such as injection site reaction. Covid-19- and vaccination-related headache are known to occur. Whether CGRP-related drugs would be of benefit in these circumstances is not yet known.
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Affiliation(s)
- Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
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Li D, Abreu J, Tepper SJ. A Brief Review of Gepants. Curr Pain Headache Rep 2023; 27:479-488. [PMID: 37531032 DOI: 10.1007/s11916-023-01142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Gepants are small molecules that antagonize calcitonin gene-related peptide (CGRP) receptors. Due to their favorable side effect profile and versatility in treating headaches acutely and preventively, gepants are preferred over triptans. We will cover the indications for the four FDA-approved gepants in adults: rimegepant, atogepant, ubrogepant, and zavegepant. This review will illustrate how gepants will continue to revolutionize the acute and preventive treatment of headaches. RECENT FINDINGS Gepants are now available in oral tablet, dissolving tablet, and intra-nasal spray formulations. Recent studies have shown promising utility in treating the pre-headache or prodromal phase. They have favorable tolerability, no evidence for association with medication overuse, and remain a safer alternative in those who have cerebrovascular risk factors. Additional research is needed to explore occurrence of Raynaud's phenomenon in participants treated with gepants, as it has been associated with CGRP monoclonal antibodies, but are not extensively studied in gepants. Gepants are expected to play a significant role in the next generation of migraine treatments.
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Affiliation(s)
- Diana Li
- Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Jessica Abreu
- Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Stewart J Tepper
- Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
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Pérez-Rodríguez A, Bandrés-Hernández P, Anciones C, Terrón-Cuadrado C, Canuet-Delis L, Gilo-Arrojo F, Anciones B. [Cardiovascular safety of new drugs for the acute and preventive treatment of migraine: gepants and ditans]. Rev Neurol 2023; 76:295-308. [PMID: 37102254 PMCID: PMC10478141 DOI: 10.33588/rn.7609.2022238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Migraine is a prevalent neurological condition characterised by disabling headache attacks. In recent decades, new drugs have been developed specifically for the acute and preventive treatment of migraine based on its pathophysiology. These include calcitonin gene-related peptide (CGRP) antagonists (CGRP) (gepants) and selective serotoninergic 5-HT1F receptor agonists (ditans). CGRP is a neuropeptide released by trigeminal terminals that acts as a vasodilator, causes neurogenic inflammation and thus generates pain and sensitisation in migraine. It also has a powerful vasodilatory action and is involved in cardiovascular regulation, which is why numerous studies are under way to assess the vascular safety of acting against CGRP. The high selectivity of ditans for the serotoninergic 5-HT1F receptor with a low affinity for other serotoninergic receptors seems to translate into little or no vasoconstrictor effect, which is mediated by the activation of 5-HT1B receptors. DEVELOPMENT The aim of our study is to review the cardiovascular safety demonstrated by these new drugs for the treatment of migraine by analysing the evidence published to date. We conducted a literature search in the PubMed database and a review of clinical trials published at clinicaltrial.gov. We included literature reviews, meta-analyses and clinical trials in English and Spanish. We analysed reported cardiovascular adverse effects. CONCLUSIONS Based on the results published to date, we can conclude that the cardiovascular safety profile of these new treatments is favourable. Longer-term safety studies are needed to confirm these results.
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Affiliation(s)
- A Pérez-Rodríguez
- Hospital Nuestra Señora del Rosario, Madrid, España
- Hospital de La Zarzuela, Madrid, España
| | | | - C Anciones
- Hospital Nuestra Señora del Rosario, Madrid, España
- Hospital de La Zarzuela, Madrid, España
| | - C Terrón-Cuadrado
- Hospital Nuestra Señora del Rosario, Madrid, España
- Hospital de La Zarzuela, Madrid, España
| | - L Canuet-Delis
- Hospital Nuestra Señora del Rosario, Madrid, España
- Hospital de La Zarzuela, Madrid, España
| | - F Gilo-Arrojo
- Hospital Nuestra Señora del Rosario, Madrid, España
- Hospital de La Zarzuela, Madrid, España
| | - B Anciones
- Hospital Nuestra Señora del Rosario, Madrid, España
- Hospital de La Zarzuela, Madrid, España
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Cullum CK, Do TP, Ashina M, Bendtsen L, Hugger SS, Iljazi A, Gusatovic J, Snellman J, Lopez-Lopez C, Ashina H, Amin FM. Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: a 52-week, single-center, prospective, observational study. J Headache Pain 2022; 23:61. [PMID: 35655137 PMCID: PMC9164431 DOI: 10.1186/s10194-022-01433-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clinical trials have shown that erenumab is effective and well-tolerated for the preventive treatment of chronic migraine. To extend the results from clinical trials, we assessed the real-world efficacy and safety of erenumab in patients with chronic migraine from the outpatient clinic at the Danish Headache Center. METHODS A 52-week, single-center, prospective, observation study of erenumab in adults with chronic migraine who are eligible for treatment with monoclonal antibodies against CGRP or its receptor in Denmark. The primary outcome was defined as proportion of patients who achieved ≥ 30% reduction in monthly migraine days (MMDs) from baseline to weeks 9-12. RESULTS A total of 300 adult patients with chronic migraine were enrolled and received at least one dose of erenumab. At baseline, the mean (SD) number of monthly headache days was 23 ± 4.9 and mean number of MMDs was 16.8 ± 6.4. Of 300 enrolled patients, 273 (91.0%) patients completed 12 weeks of treatment, and 119 (39.7%) completed 52 weeks of treatment. The number of patients who achieved ≥ 30% reduction in MMDs from baseline to weeks 9-12 was 195 (71.4%) of 273 patients. Sustained ≥ 30% reduction in MMDs at all assessment periods throughout the 52-week treatment period was achieved by 102 (34%) of 300 patients. Adverse events occurred in 220 (73.3%) out of 300 patients. The most common adverse event was constipation. Treatment discontinuation due to lack of tolerability occurred in 41 (13.7%) patients. CONCLUSIONS Among adult patients with chronic migraine and previous failure of medications for migraine prevention, erenumab was found to be effective and well-tolerated.
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Affiliation(s)
- Christopher Kjaer Cullum
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Sonja Hugger
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Afrim Iljazi
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julia Gusatovic
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Cristina Lopez-Lopez
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd Grenzacherstrasse 124, Basel, Switzerland
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurorehabilitation / Traumatic Brain Injury, Rigshospitalet, Copenhagen, Denmark
| | - Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Neurorehabilitation / Traumatic Brain Injury, Rigshospitalet, Copenhagen, Denmark.
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Atogepant (Qulipta) for migraine prevention. Med Lett Drugs Ther 2021; 63:169-71. [PMID: 35085204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Abstract
BACKGROUND Atogepant is an oral, small-molecule, calcitonin gene-related peptide receptor antagonist that is being investigated for the preventive treatment of migraine. METHODS In a phase 3, double-blind trial, we randomly assigned adults with 4 to 14 migraine days per month in a 1:1:1:1 ratio to receive a once-daily dose of oral atogepant (10 mg, 30 mg, or 60 mg) or placebo for 12 weeks. The primary end point was the change from baseline in the mean number of migraine days per month across the 12 weeks. Secondary end points included headache days per month, a reduction from baseline of at least 50% in the 3-month average of migraine days per month, quality of life, and scores on the Activity Impairment in Migraine-Diary (AIM-D). RESULTS A total of 2270 participants were screened, 910 were enrolled, and 873 were included in the efficacy analysis; 214 were assigned to the 10-mg atogepant group, 223 to the 30-mg atogepant group, 222 to the 60-mg atogepant group, and 214 to the placebo group. The mean number of migraine days per month at baseline ranged from 7.5 to 7.9 in the four groups. The changes from baseline across 12 weeks were -3.7 days with 10-mg atogepant, -3.9 days with 30-mg atogepant, -4.2 days with 60-mg atogepant, and -2.5 days with placebo. The mean differences from placebo in the change from baseline were -1.2 days with 10-mg atogepant (95% confidence interval [CI], -1.8 to -0.6), -1.4 days with 30-mg atogepant (95% CI, -1.9 to -0.8), and -1.7 days with 60-mg atogepant (95% CI, -2.3 to -1.2) (P<0.001 for all comparisons with placebo). Results for the secondary end points favored atogepant over placebo with the exceptions of the AIM-D Performance of Daily Activities score and the AIM-D Physical Impairment score for the 10-mg dose. The most common adverse events were constipation (6.9 to 7.7% across atogepant doses) and nausea (4.4 to 6.1% across atogepant doses). Serious adverse events included one case each of asthma and optic neuritis in the 10-mg atogepant group. CONCLUSIONS Oral atogepant once daily was effective in reducing the number of migraine days and headache days over a period of 12 weeks. Adverse events included constipation and nausea. Longer and larger trials are needed to determine the effect and safety of atogepant for migraine prevention. (Funded by Allergan; ADVANCE ClinicalTrials.gov number, NCT03777059.).
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Affiliation(s)
- Jessica Ailani
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Richard B Lipton
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Peter J Goadsby
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Hua Guo
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Rosa Miceli
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Lawrence Severt
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Michelle Finnegan
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
| | - Joel M Trugman
- From MedStar Georgetown University Hospital, Washington, DC (J.A.); Albert Einstein College of Medicine and Montefiore Headache Center, New York (R.B.L.); the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London (P.J.G.); the Department of Neurology, University of California, Los Angeles, Los Angeles (P.J.G.); and AbbVie, Madison, NJ (H.G., R.M., L.S., M.F., J.M.T.)
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Breen ID, Brumfiel CM, Patel MH, Butterfield RJ, VanderPluym JH, Griffing L, Pittelkow MR, Mangold AR. Evaluation of the Safety of Calcitonin Gene-Related Peptide Antagonists for Migraine Treatment Among Adults With Raynaud Phenomenon. JAMA Netw Open 2021; 4:e217934. [PMID: 33871613 PMCID: PMC8056280 DOI: 10.1001/jamanetworkopen.2021.7934] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Calcitonin gene-related peptide (CGRP) antagonists have demonstrated tremendous promise in migraine management. However, these medications decrease reflex vasodilatory response, which may lead to exacerbation of microvascular disease in susceptible patients, such as patients with Raynaud phenomenon (RP). OBJECTIVE To investigate the microvascular complications of CGRP antagonists in patients with underlying RP. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed from May 18, 2018, to September 15, 2020, in Mayo Clinic Health System patients with Raynaud phenomenon while undergoing CGRP antagonist therapy to treat migraine. Inclusion criteria were age older than 18 years, history of migraine, past or current treatment with CGRP antagonists, and diagnosis of primary or secondary RP. EXPOSURE Treatment with CGRP antagonists. MAIN OUTCOMES AND MEASURES The main outcome measure was microvascular complications (eg, worsening RP, digital ulcerations, and gangrenous necrosis) after initiation of treatment with a CGRP antagonist. Patient demographic and clinical characteristics were compared between those who experienced complications and those who did not. RESULTS A total of 169 patients (163 [96.4%] female; 151 [89.3%] non-Hispanic White; mean [SD] age, 46 [13] years) were identified. Of the 169 patients, 9 (5.3%) exhibited microvascular complications, ranging from worsening RP to gangrene and autonecrosis that required distal digit amputation. Comparative analysis did not find statistically significant differences in demographic or clinical characteristics between the 2 cohorts. All 9 patients with complications were female (mean [SD] age, 40 [12] years). Five of the 9 patients (55.6%) had previously diagnosed RP; in 3 the RP was primary, and 2 it was secondary to scleroderma. The other 4 patients (44.4%) were newly diagnosed with RP. Eight of the 9 patients (88.9%) had chronic migraine; 4 had migraine with aura, and 5 had migraine without aura. The CGRP antagonist agents temporally associated with the microvascular complications included galcanezumab (in 3 patients), erenumab (in 5 patients), and fremanezumab (in 1 patient). CONCLUSIONS AND RELEVANCE The results of this study indicate that microvascular complications of CGRP antagonist use in patients with underlying RP are uncommon. The incidence of serious adverse events, although rare, warrant caution when considering the use of these agents in patients with RP.
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Affiliation(s)
- Ilana D. Breen
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale
| | | | - Meera H. Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale
| | | | | | - Leroy Griffing
- Department of Rheumatology, Mayo Clinic Arizona, Phoenix
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Zhang Z, Shu Y, Diao Y, Du Y, Chen L, Liu Y, Du B. Calcitonin gene-related peptide receptor antagonist ubrogepant for the treatment of acute migraine: A meta-analysis. Medicine (Baltimore) 2021; 100:e24741. [PMID: 33663087 PMCID: PMC7909234 DOI: 10.1097/md.0000000000024741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The objective of this study is to systematically evaluate the efficacy and safety of the calcitonin gene-related peptide (CGRP) receptor antagonist ubrogepant for the treatment of acute migraine. METHODS Randomized controlled trials (RCTs) of ubrogepant for treatment of acute migraine were identified in PubMed, MEDLINE, EMBASE, and the Cochrane Library from database establishment to June 2020; we also searched ClinicalTrials.gov manually during the same period. Then, RevMan 5.3 software was used to perform a meta-analysis on each outcome measure. RESULTS A total of 5 RCTs involving 4903 patients were included; there were 3358 cases in the ubrogepant group and 1545 cases in the placebo group. The meta-analysis showed the following results: at 2 hours postdose, the percentages of participants reporting pain relief and the absence of photophobia, nausea, and phonophobia were significantly higher in the ubrogepant group than in the placebo group (odds ratio [OR] = 1.71, 95%CI: 1.48-1.97, P < .00001; OR = 1.33, 95%CI: 1.22-1.45, P < .00001; OR = 1.07, 95%CI: 1.03-1.11, P = .0006; OR = 1.21, 95%CI: 1.14-1.28, P < .00001). The incidence of common adverse events was similar between the 2 groups (P > .05). CONCLUSION Ubrogepant is effective and safe for the treatment of acute migraine. REGISTRATION NUMBER PROSPERO CRD42019145286.
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Affiliation(s)
- Zizhen Zhang
- School of Pharmacy, Southwest Medical University, Luzhou Sichuan
| | - Yunfeng Shu
- School of Pharmacy, Southwest Medical University, Luzhou Sichuan
| | - Yun Diao
- School of Pharmacy, North Sichuan Medical College, Nanchong Sichuan
| | - Yang Du
- Department of Psychosomatic Medicine
| | - Lizhi Chen
- School of Pharmacy, Southwest Medical University, Luzhou Sichuan
| | - Ying Liu
- School of Pharmacy, North Sichuan Medical College, Nanchong Sichuan
| | - Biao Du
- Department of Pharmacy, the Affiliated Three Gorges Hospital of Chongqing University, Chongqing, China
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Skaria T, Wälchli T, Vogel J. CGRP Receptor Antagonism in COVID-19: Potential Cardiopulmonary Adverse Effects. Trends Mol Med 2021; 27:7-10. [PMID: 33129692 PMCID: PMC7580524 DOI: 10.1016/j.molmed.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
Recently, the US FDA has authorized a drug repurposing trial with calcitonin gene-related peptide (CGRP) receptor antagonists to reduce lung inflammation in coronavirus 2019 (COVID-19). However, the well-established cardiopulmonary protective effects of CGRP raise concerns about the safety of antagonizing CGRP in COVID-19. Awareness regarding potential cardiopulmonary adverse effects may enable their early detection and prevent illness from worsening.
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Affiliation(s)
- Tom Skaria
- Institute of Veterinary Physiology and Zürich Center for Integrative Human Physiology, University of Zürich, Zürich, Switzerland
| | - Thomas Wälchli
- Department of Fundamental Neurobiology, Krembil Research Institute, University Health Network, University of Toronto, Toronto, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada; Group of Brain Vasculature and Neurovascular Unit, Division of Neurosurgery, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland; Group of CNS Angiogenesis and Neurovascular Link, Institute for Regenerative Medicine, Neuroscience Center Zürich, University Hospital Zürich, Zürich, Switzerland; Division of Neurosurgery, University Hospital Zürich, Zürich, Switzerland
| | - Johannes Vogel
- Institute of Veterinary Physiology and Zürich Center for Integrative Human Physiology, University of Zürich, Zürich, Switzerland.
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Frattale I, Ornello R, Pistoia F, Caponnetto V, Colangeli E, Sacco S. Paralytic ileus after planned abdominal surgery in a patient on treatment with erenumab. Intern Emerg Med 2021; 16:227-228. [PMID: 32557089 DOI: 10.1007/s11739-020-02407-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ilaria Frattale
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Valeria Caponnetto
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Colangeli
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
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Morollón N, Belvís R, De Dios A, Pagès N, González-Oria C, Latorre G, Santos-Lasaosa S. [Standard headache and neuralgia treatments and SARS-CoV-2: opinion of the Spanish Society of Neurology's Headache Study Group]. Neurologia 2020; 35:628-632. [PMID: 38620330 PMCID: PMC7386293 DOI: 10.1016/j.nrl.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/19/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. Material and methods We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. Results We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. Conclusions At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.
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Affiliation(s)
- N Morollón
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - R Belvís
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A De Dios
- Servicio de Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - N Pagès
- Servicio de Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C González-Oria
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Madrid, España
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario Virgen del rocío, Sevilla, España
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa. Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, España
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Affiliation(s)
- Angeliki Vgontzas
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William Renthal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Eptinezumab (Vyepti) for migraine prevention. Med Lett Drugs Ther 2020; 62:85-7. [PMID: 32555116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Rimegepant (Nurtec ODT) for acute treatment of migraine. Med Lett Drugs Ther 2020; 62:70-2. [PMID: 32555113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Dodick DW, Ailani J. Clinical Efficacy and Safety of Ubrogepant for the Acute Treatment of Migraine. J Fam Pract 2020; 69:S13-S22. [PMID: 32053715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Jessica Ailani
- Medstar Georgetown University Hospital, Washington, DC, USA
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Abstract
BACKGROUND Ubrogepant is an oral, small-molecule calcitonin gene-related peptide receptor antagonist for acute migraine treatment. METHODS We conducted a randomized trial to evaluate the efficacy, safety, and side-effect profile of ubrogepant. We assigned adults with migraine, with or without aura, in a 1:1:1 ratio to receive an initial dose of placebo, ubrogepant at a dose of 50 mg, or ubrogepant at a dose of 100 mg for treatment of a single migraine attack, with the option to take a second dose. The coprimary efficacy end points were freedom from pain at 2 hours after the initial dose and absence of the most bothersome migraine-associated symptom at 2 hours. Secondary end points included pain relief (at 2 hours), sustained pain relief (from 2 to 24 hours), sustained freedom from pain (from 2 to 24 hours), and absence of symptoms associated with migraine (photophobia, phonophobia, and nausea) at 2 hours. RESULTS A total of 1672 participants were enrolled; 559 were assigned to receive placebo, 556 to receive 50 mg of ubrogepant, and 557 to receive 100 mg of ubrogepant. The percentage of participants who had freedom from pain at 2 hours was 11.8% in the placebo group, 19.2% in the 50-mg ubrogepant group (P = 0.002, adjusted for multiplicity, for the comparison with placebo), and 21.2% in the 100-mg ubrogepant group (P<0.001). The percentage of participants who had freedom from the most bothersome symptom at 2 hours was 27.8% in the placebo group, 38.6% in the 50-mg ubrogepant group (P = 0.002), and 37.7% in the 100-mg ubrogepant group (P = 0.002). Adverse events within 48 hours after the initial or optional second dose were reported in 12.8% of participants in the placebo group, in 9.4% in the 50-mg ubrogepant group, and in 16.3% in the 100-mg ubrogepant group. The most common adverse events were nausea, somnolence, and dry mouth (reported in 0.4 to 4.1%); these events were more frequent in the 100-mg ubrogepant group (reported in 2.1 to 4.1%). Serious adverse events reported within 30 days in the ubrogepant groups included appendicitis, spontaneous abortion, pericardial effusion, and seizure; none of the events occurred within 48 hours after the dose. CONCLUSIONS A higher percentage of participants who received ubrogepant than of those who received placebo had freedom from pain and absence of the most bothersome symptom at 2 hours after the dose. The most commonly reported adverse events were nausea, somnolence, and dry mouth. Further trials are needed to determine the durability and safety of ubrogepant for acute migraine treatment and to compare it with other drugs for migraine. (Funded by Allergan; ClinicalTrials.gov number, NCT02828020.).
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Affiliation(s)
- David W Dodick
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
| | - Richard B Lipton
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
| | - Jessica Ailani
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
| | - Kaifeng Lu
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
| | - Michelle Finnegan
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
| | - Joel M Trugman
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
| | - Armin Szegedi
- From the Mayo Clinic, Phoenix, AZ (D.W.D.); Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (R.B.L.); Georgetown University Hospital, Washington, DC (J.A.); and Allergan, Madison, NJ (K.L., M.F., J.M.T., A.S.)
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Abstract
BACKGROUND Erenumab is a new medicine recently approved in the United States of America for the preventive treatment of migraine among adults. We aimed to conduct a meta-analysis and evaluation of the efficacy and safety of erenumab among patients with migraine. METHODS The electronic databases that were searched comprised PubMed, Embase and the Cochrane library, which were independently retrieved by 2 reviewers. Only randomized controlled trials (RCTs) that compared placebo with erenumab were selected. Mean differences (MDs), pooled risk ratios (RRs), and their corresponding 95% confidence intervals (CIs) were calculated for continuous and dichotomous data, respectively. RESULTS Five RCTs representing 2928 patients were included. Pooled analysis showed significant reductions in the 50% responder rate (RR 1.55; P < .00001; I = 49%). In addition, the mean monthly migraine days from baseline in the erenumab group compared with placebo (MD-1.32; P < .00001; I = 100%) and migraine-specific medication days) from baseline (MD-1.41; P < .00001; I = 100%) were significantly decreased for the erenumab group as compared with placebo. Furthermore, Migraine-specific medication days from baseline in the 140 mg erenumab group were significantly reduced as compared the 70 mg group (MD = 0.55; P < .00001; I = 90%). Finally, there was no significant difference between the erenumab group and placebo for any adverse event and serious adverse event. CONCLUSION Among patients with migraine, both 70 and 140 mg of erenumab were associated with reduced Migraine-specific medication days, Migraine-specific medication days from baseline, and an increased rate of a 50% reduction, in the absence of an increased risk of any serious adverse effect.
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Affiliation(s)
- Changyu Zhu
- Department of Pharmacy, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China
| | - Jianmei Guan
- Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital
| | - Hua Xiao
- Department of Pharmacy
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Weinan Luo
- Department of Pharmacy
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Rongsheng Tong
- Department of Pharmacy
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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Goadsby PJ, Tepper SJ, Watkins PB, Ayele G, Miceli R, Butler M, Severt L, Finnegan M, Szegedi A, Trugman JM, Jakate A. Safety and tolerability of ubrogepant following intermittent, high-frequency dosing: Randomized, placebo-controlled trial in healthy adults. Cephalalgia 2019; 39:1753-1761. [PMID: 31537107 PMCID: PMC6900570 DOI: 10.1177/0333102419869918] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ubrogepant is a novel, oral calcitonin gene-related peptide (CGRP) receptor antagonist in development for the acute treatment of migraine. This trial evaluated the safety and tolerability of ubrogepant, focusing on hepatic safety, when administered intermittently with high-frequency dosing to healthy participants. METHODS In this phase 1, multicenter, double-blind, parallel-group trial, healthy adults (age 18-50 years) were randomized 1:1 to placebo or ubrogepant. Ubrogepant was dosed at 100 mg (2 × 50 mg tablets) on 2 consecutive days followed by 2 consecutive days of placebo, alternating for 8 weeks. Primary outcome measures were safety and tolerability. RESULTS Of participants randomized (n = 518), 516 were included in the safety population (n = 260 placebo; n = 256 ubrogepant). Treatment-emergent adverse events were reported in 45% of placebo and 44% of ubrogepant participants. The most common was headache (10% placebo; 11% ubrogepant). Overall, seven cases of alanine aminotransferase and/or aspartate aminotransferase levels ≥ 3 × the upper limit of normal (five placebo, two ubrogepant) were reported and adjudicated by a panel of independent liver experts blinded to treatment. Four cases were judged unlikely related to treatment. Two cases (one placebo, one ubrogepant) were judged possibly related, and one (ubrogepant) probably related. Alanine aminotransferase increases to ≥ 3 × the upper limit of normal in the two ubrogepant cases (possibly or probably related) were transient and resolved with continued dosing; both cases were asymptomatic, with no concurrent bilirubin elevation. CONCLUSION Ubrogepant was well tolerated following intermittent, high-frequency dosing in healthy participants, with no clinically relevant signal of hepatotoxicity. TRIAL REGISTRATION NA.
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Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical
Research Facility, SLaM Biomedical Research Centre, King's College London, London,
UK
| | | | - Paul B Watkins
- Institute for Drug Safety Sciences,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Croop R, Goadsby PJ, Stock DA, Conway CM, Forshaw M, Stock EG, Coric V, Lipton RB. Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. Lancet 2019; 394:737-745. [PMID: 31311674 DOI: 10.1016/s0140-6736(19)31606-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/14/2019] [Accepted: 06/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Rimegepant, a small molecule calcitonin gene-related peptide receptor antagonist, has shown efficacy in the acute treatment of migraine using a standard tablet formulation. The objective of this trial was to compare the efficacy, safety, and tolerability of a novel orally disintegrating tablet formulation of rimegepant at 75 mg with placebo in the acute treatment of migraine. METHODS In this double-blind, randomised, placebo-controlled, multicentre phase 3 trial, adults aged 18 years or older with history of migraine of at least 1 year were recruited to 69 study centres in the USA. Participants were randomly assigned to receive rimegepant (75 mg orally disintegrating tablet) or placebo and instructed to treat a single migraine attack of moderate or severe pain intensity. The randomisation was stratified by the use of prophylactic medication (yes or no), and was carried out using an interactive web response system that was accessed by each clinical site. All participants, investigators, and the sponsor were masked to treatment group assignment. The coprimary endpoints were freedom from pain and freedom from the most bothersome symptom at 2 h postdose. The efficacy analyses used the modified intention-to-treat population, which included all patients who were randomly assigned, had a migraine attack with pain of moderate or severe intensity, took a dose of rimegepant or placebo, and had at least one efficacy assessment after administration of the dose. The safety analyses included all randomly assigned participants who received at least one dose of study medication. This study is registered with ClinicalTrials.gov, number NCT03461757, and is closed to accrual. FINDINGS Between Feb 27 and Aug 28, 2018, 1811 participants were recruited and assessed for eligibility. 1466 participants were randomly assigned to the rimegepant (n=732) or placebo (n=734) groups, of whom 1375 received treatment with rimegepant (n=682) or placebo (n=693), and 1351 were evaluated for efficacy (rimegepant n=669, placebo n=682). At 2 h postdose, rimegepant orally disintegrating tablet was superior to placebo for freedom from pain (21% vs 11%, p<0·0001; risk difference 10, 95% CI 6-14) and freedom from the most bothersome symptom (35% vs 27%, p=0·0009; risk difference 8, 95% CI 3-13). The most common adverse events were nausea (rimegepant n=11 [2%]; placebo n=3 [<1%]) and urinary tract infection (rimegepant n=10 [1%]; placebo n=4 [1%]). One participant in each treatment group had a transaminase concentration of more than 3 × the upper limit of normal; neither was related to study medication, and no elevations in bilirubin greater than 2 × the upper limit of normal were reported. Treated participants reported no serious adverse events. INTERPRETATION In the acute treatment of migraine, a single 75 mg dose of rimegepant in an orally disintegrating tablet formulation was more effective than placebo. Tolerability was similar to placebo, with no safety concerns. FUNDING Biohaven Pharmaceuticals.
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Affiliation(s)
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital/SLaM Biomedical Research Centre, King's College London, UK; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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24
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Lipton RB, Croop R, Stock EG, Stock DA, Morris BA, Frost M, Dubowchik GM, Conway CM, Coric V, Goadsby PJ. Rimegepant, an Oral Calcitonin Gene-Related Peptide Receptor Antagonist, for Migraine. N Engl J Med 2019; 381:142-149. [PMID: 31291516 DOI: 10.1056/nejmoa1811090] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Calcitonin gene-related peptide receptor has been implicated in the pathogenesis of migraine. Rimegepant is an orally administered, small-molecule, calcitonin gene-related peptide receptor antagonist that may be effective in acute migraine treatment. METHODS In a multicenter, double-blind, phase 3 trial, we randomly assigned adults with at least a 1-year history of migraine and two to eight migraine attacks of moderate or severe intensity per month to receive rimegepant orally at a dose of 75 mg or matching placebo for the treatment of a single migraine attack. The primary end points were freedom from pain and freedom from the most bothersome symptom (other than pain) identified by the patient, both of which were assessed 2 hours after the dose of rimegepant or placebo was administered. RESULTS A total of 1186 patients were randomly assigned to receive rimegepant (594 patients) or placebo (592 patients); of these, 537 patients in the rimegepant group and 535 patients in the placebo group could be evaluated for efficacy. The overall mean age of the patients evaluated for efficacy was 40.6 years, and 88.7% were women. In a modified intention-to-treat analysis, the percentage of patients who were pain-free 2 hours after receiving the dose was 19.6% in the rimegepant group and 12.0% in the placebo group (absolute difference, 7.6 percentage points; 95% confidence interval [CI], 3.3 to 11.9; P<0.001). The percentage of patients who were free from their most bothersome symptom 2 hours after the dose was 37.6% in the rimegepant group and 25.2% in the placebo group (absolute difference, 12.4 percentage points; 95% CI, 6.9 to 17.9; P<0.001). The most common adverse events were nausea and urinary tract infection. CONCLUSIONS Treatment of a migraine attack with the oral calcitonin gene-related peptide receptor antagonist rimegepant resulted in a higher percentage of patients who were free of pain and free from their most bothersome symptom than placebo. (Funded by Biohaven Pharmaceuticals; ClinicalTrials.gov number, NCT03237845.).
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Affiliation(s)
- Richard B Lipton
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Robert Croop
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Elyse G Stock
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - David A Stock
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Beth A Morris
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Marianne Frost
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Gene M Dubowchik
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Charles M Conway
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Vladimir Coric
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
| | - Peter J Goadsby
- From the Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, and Montefiore Medical Center - both in Bronx, NY (R.B.L.); Biohaven Pharmaceuticals, New Haven, CT (R.C., E.G.S., D.A.S., B.A.M., M.F., G.M.D., C.M.C., V.C.); NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital-South London and Maudsley Biomedical Research Centre, King's College London, London (P.J.G.); and the University of California, San Francisco, San Francisco (P.J.G.)
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In brief: Erenumab (Aimovig) hypersensitivity. Med Lett Drugs Ther 2019; 61:48. [PMID: 31022159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Levin M, Silberstein SD, Gilbert R, Lucas S, Munsie L, Garrelts A, Kennedy K, Everman N, Pearlman E. Basic Considerations for the Use of Monoclonal Antibodies in Migraine. Headache 2018; 58:1689-1696. [PMID: 30426478 PMCID: PMC6283065 DOI: 10.1111/head.13439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Migraine impacts more than 36 million people in the United States and 1 billion people worldwide. Despite the increasing availability of acute and preventive therapies, there is still tremendous unmet need. Potential treatments in development include monoclonal antibodies (mAbs). Appropriate use of these “biologic” treatments will necessitate an understanding of the aspects that distinguish them from traditional medications. AIM Many drug classes are prescribed for migraine treatment, but all have limitations. Recently, calcitonin gene-related peptide (CGRP) activity has shown a significant promise as a target for preventive therapy. In this review, we provide an overview of the potential role of CGRP mAbs in migraine, with a focus on their design, pharmacokinetics, safety, and immunogenicity. CONCLUSIONS The CGRP mAbs are an innovative new therapy for migraine and address the need for effective and tolerable preventive options. MAbs, including those that target CGRP or its receptor, bind to a target with high specificity and affinity and lead to few off-target adverse effects, although mechanism-based adverse reactions may occur. Unlike other therapeutic antibodies used to treat neurologic disease, CGRP mAbs do not have a target within the immune system and have been designed to avoid altering the immune system. The safety and efficacy of mAbs against CGRP or its receptors are being investigated in clinical development programs, and the first of these therapies has received regulatory approval in the United States.
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Affiliation(s)
| | | | | | - Sylvia Lucas
- University of Washington School of MedicineSeattleWAUSA
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