Galcanezumab in the prophylaxis of migraine

Abstract

The aim of preventive treatment of episodic and chronic migraine is to reduce the frequency and severity of seizures and thereby improve the quality of patients' lives. It is estimated that 38% of patients with migraine would benefit from preventive treatment. However, in clinical practice only approximately 13% of patients with migraine receive it. Intolerable side effects and lack of efficacy of pharmacological treatment are the main reasons of treatment discontinuation. It is suggested that calcitonin-gene-related-peptide (CGRP) plays a critical role in migraine pathophysiology. One of them is galcanezumab – a humanised monoclonal antibody that selectively binds to the CGRP peptide. Galcanezumab has demonstrated efficacy in EVOLVE-1, EVOLVE-2 and REGAIN trials. It significantly reduces migraine days per month versus placebo. Moreover, the quality of patients' lives treated with galcanezumab also improved. It has a favourable safety profile, similar to placebo groups. The most frequent adverse event in patients treated with galcanezumab was injection site pain. No toxic effects on the liver or negative influences on hemodynamic or laboratory parameters were reported. The discontinuation rates due to adverse events in patients treated with galcanezumab were low. In October 2019, lasmiditan was approved by FDA and EMA in prophylaxis treatment of migraine in adult patients. Currently, this medicine is not accessible in Poland.