Emerging drugs for migraine treatment: an update

ABSTRACT

Introduction: Migraine is a very frequent and disabling neurological disorder. The current treatment options are old, generally poorly tolerated and not migraine-specific, reflecting the low priority of migraine research and highlighting the vast unmet need in its management.

Areas covered: Advancement in the understanding of migraine pathophysiological mechanisms and identification of novel potentially meaningful targets have resulted in a multitude of emerging acute and preventive treatments. Here we review the known putative migraine pathophysiological mechanisms in order to understand the rationale of the most promising novel treatments targeting the Calcitonin-Gene-Related Peptide receptor and ligand and the 5 hydroxytryptamine (5-HT)1F receptor. Key findings on the phase II and phase III clinical trials on these treatments will be summarized. Furthermore, a critical analysis on failed trials of potentially meaningful targets such the nitric oxide and the orexinergic pathways will be conducted. Future perspective will be outlined.

Expert opinion: The recent approval of Erenumab and Fremanezumab is a major milestone in the therapy of migraine since the approval of triptans. Several more studies are needed to fully understand the clinical potential, long-term safety and cost-effectiveness of these therapies. This paramount achievement should stimulate the development of further research in the migraine field.

KEYWORDS:

• Migraine
• chronic migraine
• erenumab
• fremanezumab
• galcanezumab
• eptinezumab
• lasmitidan
• ubrogepant
• atogepant
• CGRP
• PACAP

Declaration of interest

P Martelletti has received research and educational funds, travel grants or fees for advisory board participation from: Teva, Allergan, Novartis, ElectroCore, Springer, Amgen and Daiichi Sankyo. G Lambru has received research and educational funds, travel grants or fees for advisory board participation from: Allergan, Novartis and Autonomic Technologies. A P Andreou has received honoraria from Allergan for consultancies advisory board participation and delivering education presentations. She has also received a research grant from eNeuro. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.