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According to a study in the New England Journal of Medicine, two
injections of the drug galcanezumab reduced the frequency of
episodic cluster headaches (ECH). And in a separate study in the
same issue of the journal, an experimental oral drug made migraine
pain quickly go away for 1 in 5 sufferers.
Cluster headaches typically appear at least once a day - often at
the same time of the day or night - for weeks or months. The pain is
typically around one eye. They eventually go away for a while but
can return after an absence of months or years.
In the galcanezumab study, 106 volunteers received two injections of
the anti-migraine medicine or a placebo, spaced one month apart. The
drug cut the average number of episodic cluster headaches by 51%
during the first 3 weeks of treatment, from 17.8 per week down to
9.1 per week. Placebo injections produced a 30% reduction, from 17.3
per week to 12.1 per week. Almost three quarters of participants saw
some reduction in headache frequency compared to about half of those
on placebo.
"Some patients get completely suppressed and many partially so,"
lead author Dr. Peter Goadsby of King's College London told Reuters
Health in an email. "I do not think one can overstate how bad a
cluster attack is."
To be eligible for the study, patients had to have at least one
attack every other day but not more than eight per day. The typical
volunteer had been dealing with the headaches for more than 16
years. The average age was about 46 years old and more than 82% were
men.
Each 300 mg injection costs about $1,400, according to the website
goodrx.com. Galcanezumab is sold under the brand name Emgality by
Eli Lilly, and the company paid for the study.
"Patients report ECH attacks as the most severe pain they experience
- bar none," including childbirth and kidney stones, said Dr.
Goadsby, director of the NIHR-Wellcome Trust King's Clinical
Research Facility and SLaM Biomedical Research Centre.
"Imagine what it's like to give birth 1-8 times a day, every day,
for 8-12 weeks a year. Imagine not a single full night's sleep for
8-12 weeks and you know next year, it will be the same," he said.
"This development is really important for these patients."
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And it may spark the development of treatments that are even more
effective, he added.
The U.S. Food and Drug Administration approved the drug as a
first-ever treatment for episodic cluster headaches in June. The
company estimates that about one quarter of a million people in the
United States suffer from them.
In contrast, migraine headaches plague about 39 million people in
the U.S., or up to 14% of the population, primarily women. Three
quarters of people who have migraines experience at least one per
month.
The migraine study looked at Biohaven Pharmaceuticals' experimental
oral drug rimegepant, and was financed by Biohaven.
Researchers found that 19.6% of the 537 volunteers who took it while
suffering from a migraine were free of pain within two hours
compared to 12% of the 535 volunteers given placebo.
Half the patients in both groups had their pain relapse 2 to 48
hours after the dose. Unlike conventional treatment with triptan
drugs, taking a second dose doesn't provide additional relief, lead
author Dr. Richard Lipton, director of the Montefiore Headache
Center in New York City told Reuters Health in a telephone
interview.
"Triptans are well-established therapies; maybe 25% of people with
migraines are currently on a triptan," said Lipton, who is also in
the department of neurology at the Albert Einstein College of
Medicine. "If it works well for them, they're not going to be
candidates on this drug. This is for people with contraindications
for a triptan" or people who get no relief from triptans.
Triptan therapy costs about $7,000 a year, he said, and when it
comes to rimegepant, "I'm very hopeful the drug will be affordable
because there are a lot of people who need it."
SOURCES: https://bit.ly/2XvYpE0 and https://bit.ly/2LHpr9a The New
England Journal of Medicine, online July 10, 2019.
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