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Eptinezumab for preventing migraine

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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:

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