Monoclonal antibodies against migraine

A new class of drugs promises to significantly alleviate chronic headache.

Ten fewer days of migraine per month in patients over 65 years of age is what, on average, the new anti-CGRP monoclonal antibodies achieve, according to a recent study led by the Bellvitge University Hospital (HUB) in Hospitalet. de Llobregat, Barcelona, ​​and the Bellvitge Biomedical Research Institute (IDIBELL), located in Hospitalet de Llobregat and which is one of the CERCA institutions of the Generalitat of Catalonia.

The results of this study open new avenues to improve the quality of life of people who suffer from migraines.

18 Headache Units from hospitals throughout Spain participated in the study.

The main conclusion of the study is that anti-CGRP monoclonal antibodies are also effective and safe in people over 65 years of age.

Having this information available was a pending issue, since this patient profile was excluded from clinical trials. Now it has been shown that this treatment represents a safe and effective therapeutic option for the management of chronic migraine in these patients.

Anti-CGRP monoclonal antibodies are drugs available since 2019 that precisely block CGRP, a protein involved in the pain and vasodilatation processes associated with migraine. Due to their specific action on the protein, they are very well tolerated and effective drugs with no effects at other levels (except constipation, because the protein is also found in the neurons of the intestines), since they block the pain pathway associated with migraine.

The results of the study determine that 60% of the patients have presented a reduction of more than 50% of days that they suffered migraine. An observational study has been carried out, with a sample of 162 patients, 74.1% of whom were women.

After six months of treatment with any monoclonal antibody (erenumab, galcanezumab and fremanezumab), patients have gone from an average of eighteen migraine days per month to just eight. These results are comparable to what was already known about monoclonal antibodies in the general population. Regarding adverse effects in those over 65 years of age, fewer have been detected with the administration of fremanezumab.

In parallel, the headache frequencies and the consumption of analgesics in the study sample of patients have been significantly reduced and the clinical evaluation scales have improved.

Research team members. (Photo: IDIBELL)

More therapeutic arsenal to combat chronic migraine

“Migraine is a genetic disease that has no cure and that fluctuates throughout life. In elderly patients where it has not been possible to adequately control the migraine, there is a greater risk of chronification due to the time of evolution, due to having failed more preventive treatments and due to associated comorbidity”, explained Dr. Albert Muñoz-Vendrell, IDIBELL researcher, neurologist at the Bellvitge Hospital Headache Unit and co-author of the new study.

People over the age of 65 were not included in clinical trials of monoclonal antibodies, so it was not known until now whether they were as effective in younger migraineurs.

“The hypothesis was that they could suffer from more safety problems, since CGRP is a vasodilator and theoretically if the protein is blocked, there could be an increased cardiovascular risk in elderly patients with hypertension, dyslipidemia, or a history of previous cardiovascular events,” according to the IDIBELL researcher. This latest study clears up the pending doubts about these treatments that extend the current approach to migraine, with good tolerance and safety.

Many people in the world suffer from migraine. In Catalonia alone, the estimated number of people who suffer from it is close to 900,000 people, especially young women. Although the prevalence is lower in those over 65 years of age, comorbidity and chronicity may limit the prescription of treatments and the response to them. The impact of migraine on the quality of life of patients is very serious, since migraine attacks represent an almost complete disability because the symptoms are not limited to headache, but are also associated with nausea, as well as intolerance to external stimuli and physical activity.

In fact, the WHO considers it the sixth most disabling disease in the world and is the second cause of disability among neurological diseases, only behind stroke.

The study is titled “Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients”. And it has been published in the academic journal The Journal of Headache and Pain. (Source: IDIBELL)