New drug hope for people with severe migraines
The first medicine designed to prevent migraines was approved by the Food and Drug Administration recently, ushering in what many experts believe will be a new era in treatment for people who suffer the most severe form of these headaches.
The drug, Aimovig, made by Amgen and Novartis, is a monthly injection with a device similar to an insulin pen. The list price will be $6,900 a year, and Amgen said the drug will be available to patients within a week. Aimovig blocks a protein fragment, CGRP, that instigates and perpetuates migraines. Three other companies — Lilly, Teva and Alder — have similar medicines in the final stages of study or awaiting F.D.A. approval. “The drugs will have a huge impact,” said Dr Amaal Starling, a neurologist and migraine specialist at the Mayo Clinic in Phoenix. “This is really an amazing time for my patient population and for general neurologists treating patients with migraine.”
Millions of people experience severe migraines so often that they are disabled and in despair. These drugs do not prevent all migraine attacks, but can make them less severe and can reduce their frequency by 50 percent or more.
As a recent editorial in the journal JAMA put it, they are “progress, but not a panacea.”
Until now, drugs used to prevent migraines were designed to treat other diseases, like high blood pressure. They are not very effective, may work only temporarily, and often are laden with intolerable side effects.
In clinical trials, people taking the new drugs reported no more side effects than those taking a placebo. The side effects over the long term and among people with chronic diseases remain to be determined.
“For now, they look fantastic,” Dr. Stewart J. Tepper, a professor of neurology at Dartmouth College, said of the new drugs. “They shake the ground under our feet. They will change the way we treat migraine.” Dr. Tepper and Dr. Starling, like most leading migraine specialists, have consulted with the drug companies and enrolled patients in their clinical trials.
One in seven people worldwide experience migraines, among them 37 million Americans — as many as 20 percent of women, and 10 percent of men. About 2 per cent of the global population copes with chronic migraines. By some estimates, migraine is the third most common disease in the world, and it ranks among the top ten causes of disability.
It is not just a headache: A migraine often is accompanied by disabling symptoms like nausea and vomiting, difficulty speaking, and an aversion to light and noise. The headache can be throbbing and last for hours or days.
The new medicines are intended for the estimated 2.8 million Americans who have a migraine many times each month. Treating these people has been challenging, doctors say. Patients often try the currently available treatments one after another, in varying combinations.
Drug side effects are frequent and include mental fogginess, sedation, weight gain, sexual dysfunction and dry mouth leading to cavities.
Some patients find the side effects worse than the migraines. Eighty-five per cent of migraine patients stop taking the drugs within a year.