The Impact of CGRP Inhibitors on Patients and Providers

October 31, 2018

The president of the American Headache Society shared her thoughts on how preventive medicines can alter migraine treatment for the better.

Kathleen B. Digre, MD

For Kathleen B. Digre, MD, the chief of the Division of Headache and Neuro-Ophthalmology at the University of Utah, and the president of the American Headache Society, the introduction of the calcitonin gene-related peptide (CGRP) inhibitors for migraine were welcomed, mainly because she treats patients with this condition.

For other providers, this class was perhaps welcomed for another reason: they too suffered from migraines. With far more patients suffering from the condition than there are available to treat it, the idea of the physicians having the condition as well is daunting. Which is why the availability of an efficacious and preventive class is such a bright spot on the treatment paradigm.

To provide some of her thoughts on the class and its ability to help both patients and providers in multiple ways, as well as what their success means for the research that brought them forward, Digre spoke with NeurologyLive in an interview.

NeurologyLive: What has changed for you, knowing that these CGRP inhibitors have been FDA approved?

Kathleen Digre, MD: I’m very excited for my patients because in the past, we’ve developed triptans, which were a migraine specific acute treatment, but this is really the first migraine specific preventative treatment for people with migraine, both episodic and chronic migraine and maybe even cluster in some cases. So, for my patients, I’m extremely excited because not every medication works for everybody and trying to find something that can work for some of our people that are either disabled or have frequent migraine is always a challenge to every provider who takes care of anybody with headaches. Overall, I would just say I’m very excited we have a whole new class of medications.

The other thing that I’m excited about is that the scientific understanding that calcitonin gene-related peptide was involved in the migraine process, then using that scientific discovery to come up with medications to address that specifically tells us that we can study the biology of migraine and then come up with better treatments for our patients.

The topic of physicians with migraine has come up recently. How does this help physicians prevent their own attacks?

I hope every physician with migraine has seen a care provider, either a primary care provider or a neurologist to talk about migraine and get it diagnosed properly. That’s the first step in any kind of treatment, to have the correct diagnosis. And so, I would hope that they would start with that.

Secondly, I’m sure that every provider who’s had migraine—I would hope—knows all the many different ways preventing migraines besides medication: getting rest, regular exercise, and in some cases avoiding trigger factors.

Then thirdly, I would hope that every provider with migraine would have come up with some mechanism, especially if they have frequent migraine or chronic migraine, to prevent their migraines. While many of the medications that we’ve used for migraine such as anticonvulsants, anti-hypertensives, tricyclic anti-depressants, don’t work for everybody, many of those medications can be efficacious for some people. I do think this class of drug offers hope to a lot of people who probably haven’t done well on other medications or have had terrible adverse effects from medications that may have controlled their migraine. I’m hopeful for practitioners who also have migraines.

Were there any specific data or information that makes one of these agents stand out?

The whole class is exciting because this is a completely different class of drug from what we had before. The other thing that makes it exciting is that all of these are injectable and last for a month or longer in some cases. One of the hardest parts of taking care of people with migraine is finding something that they can stick with that can actually be taken properly. This allows us to have a treatment that most likely may work better just because they’ll be not only have better tolerance, because the side effects are much lower than any other medications, but also the treatment adherence will be most likely better as well. We don’t have all the answers for these medications. But in the trials that we’ve got, the phase 3 trials each has had to undergo have been very promising, but we all will have to pay attention to how people do in a real-world situation.

Transcript edited for clarity.