Can Using Monoclonal Antibodies for Migraine Prevention Finally Bring a Long-Awaited Cure?
When most people develop a headache, they can rely on a number of over-the-counter drugs to treat the problem. In most circumstances, these medications will alleviate the pain within a reasonable amount of time. Unfortunately, migraines are not regular headaches. A migraine can last anywhere from 4-72 hours, with chronic sufferers experiencing them more than 15 days a month. In addition to the debilitating pain that characterizes the condition, migraines are often accompanied with nausea, auras, and sensitivities to light and sound. Approximately 730 million people suffer from migraines worldwide, making it the most common neurological condition today.1 Given the number of afflicted people, we would assume that there would exist a variety of drugs and therapies to treat and cure them. The reality couldn’t be further from the truth.
Current Methods of Treating Migraines Fall Short
Despite being aware of the condition for several centuries, we have yet to truly understand the biological mechanisms that cause migraines. Until triptans were introduced in the 1990s, there were no therapies specifically targeting the condition. Instead, many sufferers are prescribed drugs designed to address other diseases and disorders. As a result, migraine patients take medications originally intended to treat epilepsy, depression and blood pressure.
This solution is an imperfect one; taking these off-indication medications is only 45% effective. In addition, they only stop attacks after they start and do not prevent migraines from happening. Factor in the unwanted side effects using these non-migraine related medications and it encourages us to discover a better approach. After all, even economic pressures support the need for a preventative option. When we combine the direct medical costs of treating migraines with the hours lost due to time taken off from work, the condition can cost up to $17 billion annually.
Exploring the Option of Using Monoclonal Antibodies for Migraine Prevention
The concept of treating migraines with off-indication medications or only after they start may soon come to an end, however. Thanks to an improved understanding of biological mechanisms and the ability to tailor proteins to bind to specific targets, the possibility of successfully using monoclonal antibodies for migraine prevention may become a reality. Our current understanding is that multiple factors are associated with an attack. Triptans, for example, work because they act on both blood vessels and serotonin receptors, which are implicated in migraine headaches.2
One root cause, however, may be the calcitonin gene-related peptide (CGRP), which is typically found in high amounts during an attack. Several companies are currently developing monoclonal antibodies targeting the protein, a few of which are offering promising results. One of the biologic drug candidates has been shown to decrease the number of attacks experienced by chronic sufferers by 60% in clinical trials. Even better, 16% of patients suffered no migraines at all for 12 weeks out of the 24-week trial period. So not only do the biologic drugs work better than current off-indication medications with fewer side effects, they can prevent the headaches as well.
If at least one of the drugs currently in trials can garner enough efficacy and safety data to receive FDA approval, it will have the potential to revolutionize the field of migraine treatment. Triptans were first made available on the pharmaceutical market more than twenty years ago, which is a long time to wait for a more effective therapy. Even with these monoclonal antibodies currently in testing, the potential market presented by migraine sufferers remains relatively untapped. What other proteins are implicated in an attack? In terms of other approaches, clinical data suggests a hereditary component to migraine headaches. Would developing biotherapies targeting genes or even cells be a feasible route of study?
The most attractive part about using monoclonal antibodies for migraine prevention rests with its potential. It proves the possibility of developing highly specific, well-tolerated biologics that can prevent a neurological problem.3 If we can create functional monoclonal antibodies for migraine prevention, what other neurological conditions can we address with the same level of specificity and tolerance? These results suggest the existence of other avenues biopharmaceutical companies can pursue.
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- “New Nerve Drugs May Finally Prevent Migraine Headaches,” December 1, 2015, http://www.scientificamerican.com/article/new-nerve-drugs-may-finally-prevent-migraine-headaches/ ↩
- “Drugs to Prevent Migraine Headaches May Be on the Way,” June 17, 2015, http://www.healthline.com/health-news/drugs-to-prevent-migraine-headaches-may-be-on-the-way-061715#2 ↩
- “Monoclonal Antibodies Promising for Migraine Prevention,” July 3, 2014, http://www.medscape.com/viewarticle/827838 ↩