Unmet needs and pipeline

In a presentation about migraine medication, Prof. Christian Lampl (Headache Medical Center, Austria) argued that, despite recent developments, there is still a need for more treatment options for acute migraine. Prof. Lampl gave an overview of the most important compounds currently in development, including ditants, gepants, and antibodies [1].

Triptans are the gold standard for acute migraine treatment, but have class contraindications that limit their use in patients with cardiovascular diseases. Calcitonin gene-related peptide (CGRP) antagonism does not cause vasoconstriction, making it safe for migraine patients who cannot use triptans. CGRP receptor antagonists (gepants) do not have vasoconstrictive properties either; in phase 2 and 3 trials they have demonstrated similar efficacy to triptans, with fewer side effects.

Three new gepants (rimegepant, ubrogepant, and atogepant) are still in a developmental stage. Results from phase 2 and 3 trials showed they are effective, well tolerated, and safe, especially in terms of liver toxicity.

Apart from CGRP, one of the other members of the CGRP family of neuropeptides is amylin. Prof. Lampl said that targeting neuropeptides such as pituitary adenylate cyclase-activating peptide (PACAP) and amylin, which have similar functions as CGRP, are promising targets for migraine treatment. Clinical trials are planned for the PACAP38 receptor antagonist ALD 1910. The PAC1 receptor antagonist AMG-301 is in phase 2 development for the prevention of migraine.

Therapeutics that are not yet available in Europe but have already been approved by the American FDA are lasmiditan (tablet, acute migraine), ubrogepant (tablet, acute migraine), and rimegepant (tablet and fast dissolving tablet, acute migraine). Vazegepant (nasal spray, acute migraine) is ready to advance into a phase 3 trial. Atogepant (tablet) is in phase 2/3 development for the prevention of migraine.

1. Lampl C. Symposium SYMP09, EAN 2020.

 



Posted on 9 September 202023 April 2024