Calcitonin Gene-Related Peptide Antibodies (CGRP) for ...

Aimovig is available in Australia with a prescription. Patients can self-administer Aimovig 70mg or 140mg once a month via a SureClick autoinjector. Learn more about Aimovig here >>

Ajovy was added to the PBS on August 1st, 2021. PBS pricing is available for people with chronic migraine with a new prescription from a neurologist or GP. On November 1st, 2023, PBS access was expanded to include people with treatment-resistant high frequency episodic migraine. It is available as either a quarterly (675 mg) or monthly (225mg) prefilled syringe dose that can be administered at home or at a doctor’s office. If you don’t fit the PBS criteria you can still get a private prescription, which is available at a discounted price through the Momentum Program. When you receive your private prescription, your doctor will provide you with the next steps to purchase Ajovy. Read our comprehensive article about Ajovy here >>

Emgality has also been added to the PBS. It is approved for people with a diagnosis of chronic migraine or high frequency episodic migraine and requires a prescription from a neurologist or GP to access PBS pricing. It can also be purchased at the full cost for people who don’t fit the PBS criteria. It is available as a once-monthly self-administered injection. To commence, a loading dose is administered with 120 mg followed by another dose of 120 mg for a total of 240 mg initially. Doses are continued with one 120 mg injection each month thereafter. Read our comprehensive article about Emgality here >>

Vyepti is an intravenous treatment, to be administered every 3 months. It was added to the PBS on August 1, 2023. PBS pricing is available for people with chronic migraine (15 or more headache days per month). You can learn more about Vyepti here >>

You can visit our New Treatment Updates page for further details about pricing and PBS eligibility. To receive updates about migraine treatments, news, events, and more, subscribe to the Headache Register.

Fortunately, even after the launch of the CGRP antibodies, trials are still expected to continue to evaluate all the usage, marketing, and safety data. To see if you’re eligible to participate in the current studies being held visit www.clinicaltrials.gov and search for “Migraine CGRP” and look for studies being conducted in Australia.

CONSIDERATIONS

This is the first preventative treatment designed specifically for migraine patients which is very exciting. The positive results of the studies should give hope to many. There are however a few important things to note:

1. It’s going to be expensive: Dr. Peter Goadsby, one of the researchers on the projects has already been quoted saying that this will not be a cheap treatment. Monoclonal antibodies are the same type of treatment used in cancer and can be very expensive. Monthly injections in a clinic may also come with a cost. Due to the expense it is likely that subsidised use will need to be restricted to a subgroup of migraine patients and only continued if there is an excellent response.

1. They are delivered by injection. Which doesn’t suit many people and is not the easiest format to administer.
2. They are strong. The half life of Vypeti, for example, is 31 days. That means after 31 days after you’ve taken the treatment, 50% of the drug is still circulating and taking effect in your system.
3. This is not a final cure. Phase 2 clinical trials show between 50-70% of patients experiencing a 50% or greater reduction in migraine days. It’s not a cure and acute treatments will still be required for many.

Overall, the fact that we are getting the first wave of treatments specifically for migraine has many people rightly excited.

For the medical community, migraine has traditionally been the black sheep of the family with historically little progress or promise in the field. Now, that’s changing. With more progress comes further research, funding, and publicity which is sorely needed.

Most importantly are these strides towards better care and treatment for all of us out there suffering. If you’re struggling at the moment hold on, there is more hope than ever for a better future.

WHAT TO DO IN THE MEANTIME?

Patients are encouraged to partner with their right doctor. (7)

“Find a physician who interested in the condition and knows something about it and wants to work with them to get the best current treatment.”

— Dr. Peter Goadsby, Migraine World Summit 2017

There are many people with migraine in Australia who meet the criteria for preventative treatment. However only a small percentage of them are using preventives. (8) The side effects of older medicinal preventatives are common and difficult to tolerate. There are many alternative preventative treatments which have been shown to benefit those with migraine.

Ultimately you’ll need to find what works for you in partnership with your doctor.

SOURCES

1. ‘What Are Peptides’ Zealand Pharma. Archived from the original on 6 Apr 2014.
2. Bigal, M. Burstein R. et.al. Targeting Calcitonin Gene-Related Peptide (CGRP) for Prevention of Migraine. Webinar. 12 Feb 2015.
3. Hasen, JM. Hauge, AW. et.al. ‘Calcitonin gene-related peptide triggers migraine- like attacks in patients with migraine with aura’. Cephalalgia 2010 Oct;30(10):1179-86. doi: 10.1177/0333102410368444.
4. Connor KM, Shapiro RE, Diener H-C, et al. Randomized, controlled trial of telcagepant for the acute treatment of migraine. Neurology. 2009;73(12):970-977. doi:10.1212/WNL.0b013e3181b87942.
5. Dodick, David W et al. ‘Safety and efficacy of LY2951742, a monoclonal antibody to calcitonin gene-related peptide, for the prevention of migraine: a phase 2, randomised, double-blind, placebo-controlled study.’ The Lancet Neurology , Volume 13 , Issue 9 , 885 – 892
6. Dodick, David W et al. ‘Safety and efficacy of ALD403, an antibody to calcitonin gene-related peptide, for the prevention of frequent episodic migraine: a randomised, double-blind, placebo-controlled, exploratory phase 2 trial’ The Lancet Neurology , Volume 13 , Issue 11 , 1100 – 1107
7. Dumas, PK. ‘Free at last? New CGRP Drugs To Prevent Migraine Attacks For Most’. MigraineAgain.com June 23, 2015
8. Lipton, R.B., Bigal, M.E., Diamond M., et. Al. (2007), Migraine prevalence, disease burden, and the need for preventive therapy, Neurology, 68:343-349, doi: 10.1212/01.wnl.000025280897649.21
9. Goadsby, P. J., L. Edvinsson, and R. Ekman. “Vasoactive peptide release in the extracerebral circulation of humans during migraine headache.” Annals of neurology 28.2 (1990): 183-187.
10. Sun, Hong, et al. “Safety and efficacy of AMG 334 for prevention of episodic migraine: a randomised, double-blind, placebo-controlled, phase 2 trial.” The Lancet Neurology 15.4 (2016): 382-390.
11. Bigal, Marcelo E., et al. “Safety, tolerability, and efficacy of TEV-48125 for preventive treatment of high-frequency episodic migraine: a multicentre, randomised, double-blind, placebo-controlled, phase 2b study.” The Lancet Neurology14.11 (2015): 1081-1090.

Originally published at MigrainePal.com