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New Migraine Drugs May Help Prevent Headaches Before They Start

From TIME - November 30, 2017

One in seven Americans suffers from migraines, and medications currently prescribed to prevent themlike blood-pressure drugs and antidepressantsdont work for many people. But two new studies offer hope for those who havent respond well to existing treatments. In late-stage clinical trials, a new type of drug reduced migraine frequency and severity by up to 50% in some people.

The two studies were published this week in the New England Journal of Medicine. One study tested the effectiveness of the drug erenumab, co-developed by Novartis and Amgen, in a trial of 955 people with migraines. The other study involved 1,130 people and tested the effectiveness of Teva Pharmaceuticals fremanezumab. Both drugs have been submitted for approval by the Food and Drug Administration, and their manufacturers hope to introduce them to the market in 2018.

In the new 6-month erenumab study, 43% of people given a low-dose monthly injection of the drugand 50% of patients given a high-dose monthly injectionreported that their migraine frequency and severity was reduced by about half. Only about 27% of people who received a placebo injection reported such improvement.

Before the study, people reported having migraines an average of eight days a month. That number was reduced by 3.2 days for people who got the low dose of the drug, and by 3.7 days for those who got the higher dosebut only by 1.8 days for those who got the placebo.

The fremanezumab study tested both a monthly and a quarterly drug injection against a placebo. After three months, 41% of those whod received the drug once a month reported their headaches had been reduced by at least half, compared to just 18% of those who had received the placebo. In a third group, which received the drug injection just once over the three-month period, 38% of people reported this level of improvement.

Both groups that received at least one fremanezumab injection reported between four and five fewer headache days a month, out of an average of 13 days at the start of the study. People who received three placebo injections reported only 2.5 fewer headache days.

Erenumab and fremanezumab are monoclonal antibodies: lab-produced drugs that mimic immune cells in the body by binding to specific proteins. Both drugs target a substance called calcitonin gene-related peptide (CGRP), which is released by the body during migraines. Scientists arent sure how exactly CGRP influences migraine pain, but they suspect it alters blood-vessel activity and nerve sensations in the brain. By blocking this peptide, they hope to reduce or prevent migraine occurrences.

The new studies show that antibody therapies dont work for everyone. But the fact that they were able to help a subset of people who hadnt responded to other types of medications is a big deal, says Dr. Peter Goadsby, professor of neurology at University College London and co-author of the erenumab study.

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