Advances in pharmacotherapy for the prophylactic treatment of resistant and refractory migraine

ABSTRACT

Introduction

Refractory migraine is associated with low quality of life and great socioeconomic burden. Despite high need for effective, tolerable preventive therapies, there has been little research on potential therapeutic options. Monoclonal antibodies (mAbs) against Calcitonin Gene-Related Peptide (CGRP) are the first preventive therapeutic approach for migraine based on the underlying pathophysiology.

Areas covered

Following a brief introduction into the term ‘refractory migraine,’ the authors reviewavailable treatment options, focusing on current phase III trials of substances acting on the CGRP pathway.

Expert opinion

No uniform definition for refractory migraine is available. The vast majority of proposals recommend treatment failure of 2–4 drug classes as a key diagnostic criterion. Phase III studies on CGRP-(receptor) mAbs demonstrated excellent efficacy and tolerability in patients with chronic and episodic migraine including subjects with multiple unsuccessful conventional therapy attempts. However, more comparator trials showing superiority of mAbs versus oral preventatives, such as the HER-MEs study are needed. In summary, with the CGRP antibodies, a group of drugs has entered the market which will most likely not only significantly improve the quality of life of many individual migraine patients but could also reduce indirect health-care costs associated with migraine by reducing recurrent medical consultations.

KEYWORDS:

• CGRP
• resistant
• onabotulinumtoxin
• prophylaxis
• chronic migraine

Declaration of Interest

U Reuter has received research grants from BMBF NVF1_2017-098 and Novartis. He has also received financial support for presentations, consulting, or advisory board meetings from Amgen, AbbVie, Allergan, Eli Lilly and Co., Lundbeck, Novartis, Medscape, Pfizer Inc., StreaMedUp and Teva and has participated in clinical trials and has received institutional fees from Amgen Inc, AbbVie, Allergan, Biohaven, Eli Lilly and Company, Lundbeck, Novartis and Teva. B Raffaelli has received grants from the Charite Clinician Scientist Program, DMKG, Allergan and Novartis as well as financial support for presentations or advisory board meetings from Eli Lilly and Company, Novartis and Teva. She has also received institutional fees from participation in clinical trials from Amgen, AbbVie, Allergan, Biohaven, Eli Lilly and Company, Lundbeck, Novartis and Teva. 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.