Eptinezumab for preventing migraine

Eptinezumab for preventing migraine

NICE state:

• Eptinezumab is recommended as an option for preventing migraine in adults, only if:
  • they have 4 or more migraine days a month
  • at least 3 preventive drug treatments have failed and
  • the company provides it according to the commercial arrangement
• stop eptinezumab after 12 weeks of treatment if:
  • in episodic migraine (fewer than 15 headache days a month), the frequency does not reduce by at least 50%
  • in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine), the frequency does not reduce by at least 30%
• NICE committee note:
  • are no clinical trials directly comparing eptinezumab with erenumab, fremanezumab or galcanezumab
  • an indirect comparison suggests that eptinezumab works as well as these treatments

Eptinezumab is a relatively safe drug for the prevention of migraines with treatment-related adverse events occurring at a low frequency (2):

• is a humanized IgG1 monoclonal antibody produced by recombinant DNA techniques within yeast cells of Pichia pastoris
  • during a migraine, the trigeminal nerve conducts the pain signal via CGRP into the brainstem and to higher order regions of the brain
  • eptinezumab is hypothesized to prevent migraines by binding to (and blocking) CGRP molecules
  • can specifically and rapidly bind to both alpha- and beta-CGRP ligands to block it from binding to CGRP receptors
    • is slow to dissociate, which might explain its rapid onset and longer duration of effect
    • has a half-life of about 28 days
• has a safe profile in patients with comorbidities like obesity and type 1 diabetes
• most frequent adverse events observed were nasopharyngitis, upper respiratory tract infections (URTIs), and sinusitis and were usually mild
• development of anti-drug antibodies was common, but they declined to undetectable levels with continued dosing and did not appear to impact the overall safety profile of the drug

Reference:

• NICE (March 2023). Eptinezumab for preventing migraine
• Datta A, Maryala S, John R. A Review of Eptinezumab Use in Migraine. Cureus. 2021 Sep 16;13(9):e18032.