Christopher Gottschalk, MD

“Now we have the ability to say, ‘here’s a package that will reduce the frequency for attacks and reduce the need for these other drugs, which work, but you need to be careful with how much you use them…’ That’s a terrific deal. That’s saying you can use the right drugs when you need them.”

In the past year, 3 new preventive migraine treatments—the anti-calcitonin gene-related peptide (CGRP) inhibitors&mdash;have come to market, and a fourth, eptinezumab, is hopefully on the way. Meanwhile, as more data is collected on the CGRP inhibitors, a number of acute CGRP targeting monoclonal antibodies&mdash;the gepants&mdash;have been moving up the clinical development ladder.

With so much on the horizon for the treatment of migraine, the future looks bright. However, with the migraine specialist’s arsenal increasing drastically in size, questions arise about dosing, subgroup efficacy, medication pairing, and much else. To discuss what’s been uncovered about these CGRP inhibitors now that long-term safety data is available, 

 spoke with Christopher Gottschalk, MD, director, headache medicine, and chief, general neurology, Yale Medicine, at the 

2019 American Headache Society (AHS) Annual Meeting

, July 11-14, 2019, in Philadelphia, Pennsylvania.

Gottschalk shared his insight into the safety profiles of these medications, and what the lack of concern there means for how often these drugs can be prescribed. As well, he discussed how he envisions the treatments may be utilized in clinical practice going forward.

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The director of headache medicine and chief of general neurology at Yale Medicine discussed the long-term success the new preventive migraine therapies have shown thus far, and how the lack of safety concerns will improve how they’re utilized.

Christopher Gottschalk, MD: Long-Term Safety in Preventive Migraine Therapies

“We know that, for all the other prevention drugs for migraine we’ve had up until now, the adherence rates are terrible. If you prescribe a prescription for a daily medication, a month later, half of [patients] aren’t even refilling it, and 6 months later, half of those [who are] have stopped, too. That’s a bad landscape to start from.”

Despite having acute and preventive migraine medications available for some time, the adherence rates to these treatments can be essentially abysmal for a number of reasons, from adverse effects to poor response. However, with the recent introduction the calcitonin gene-related peptide (CGRP) inhibitors into the market, there’s a bright light on the horizon.

Even more exciting is that one of the upcoming members of the class, eptinezumab, has shown success in a quarterly infusion dose, as opposed to the other members of the class, which are available in monthly doses. And while eptinezumab still needs regulatory approval, its unique dosing regimen presents a positive for patients in addition to its long-term and sustained efficacy in clinical trials, which has been particularly promising. At the 

, July 11-14, 2019, in Philadelphia, Pennsylvania, a number of poster presentations highlighted that data.

 sat down with Christopher Gottschalk, MD, director, headache medicine, and chief, general neurology, Yale Medicine, to talk about the eptinezumab and the CGRP class, as well as the potential for these therapies to improve the lives of patients with migraine who struggle to remain adherent.

The director of headache medicine and chief of general neurology at Yale Medicine spoke about the significance of having CGRP inhibitors in migraine treatment, and how eptinezumab fits into the treatment landscape.

Christopher Gottschalk, MD

Articles

Christopher Gottschalk, MD: Long-Term Safety in Preventive Migraine Therapies

Christopher Gottschalk, MD: Advantages of Eptinezumab and CGRP Inhibitors