Advances in orally administered pharmacotherapy for the treatment of migraine

ABSTRACT

Introduction: Migraine is a common and highly disabling neurological disorder whose acute treatment remains problematic and unsatisfactory in a high percentage of cases. Consequently, there remains a need for new symptomatic therapies that can be easily handled by patients (i.e. by oral administration).

Area covered: This review reports on compounds currently under development for the oral treatment of acute migraine attacks, focusing on Calcitonin-Gene-Related-Peptide receptor antagonists, specifically ubrogepant and rimegepant. This article is based on literature obtained from PubMed and publicly available clinical trial data.

Expert opinion: Both reviewed compounds meet the need for rapid and effective pain control, combined with the control of associated bothersome symptoms while also lacking significant adverse events and safety concerns. Though further studies should assess the profile of these compounds comparatively with existing and available treatments (namely triptans), the currently available data points to these new therapies as being very promising new symptomatic oral treatments of migraines.

KEYWORDS:

• Oral treatment
• migraine
• CGRP receptor antagonists
• ubrogepant
• rimegepant

Article highlights

• Migraine affects 15% to 18% of the general world population, women three times more than men

• Migraine is the first cause of disability worldwide in under 50s

• Monoclonal antibodies against CGRP or its receptor are entering the market for preventative use

• Antagonist of CGRP receptor are under development for the treatment of migraine attack

• Ubrogepant and Rimegepant are two novel oral CGRP antagonists promising drugs for the acute treatment of migraine

• Phase 3 studies for both Ubrogepant and Rimegepant proved to be effective in the treatment of acute migraine attacks, with no safety concerns

This box summarizes key points contained in the article.

Declaration of interest

P Martelletti is on the advisory board of Amgen Inc, Novartis, Teva Pharmaceuticals and Allergan. Furthermore, P Martelletti is on the speaker’s bureau of Eli Lilly, Allergan and Teva while having also received a research grant from Allergan. Meanwhile, MA Giamberardino has received congress fees from Helsinn, Epitech and IBSA. They have also received research funds for topics unrelated to this manuscript from Epitech and Helsinn. 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

One referee is on the advisory boards and/or speaker bureaus of Alder, Allergan, Amgen Inc, Novartis, Eli Lilly and Company, Teva Pharmaceuticals, Promius and Depomed Inc. Another referee is on the advisory boards of Biohaven, Eli Lilly and Company, Amgen/Novartis, Alder and Promius. They have also been a principle in investigator for studies sponsored by Biohaven, Amgen Inc, Eli Lilly and Company, Teva Pharmaceuticals, Alder, Allergan, Roche, Genentech and ViroMed (VM Biopharma). They have also acted as a speaker for Amgen/Novartis, Teva Pharmaceuticals and Eli Lilly and Company.

Additional information

Funding

This manuscript was not funded.