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Highlights from the Annual Meeting of the American Academy of Neurology

Over 2000 scientific abstracts were presented in multiple formats at this year’s Virtual Annual Meeting of the American Academy of Neurology (17-22 April 2021). Highlights of presentations on anti-CGRP therapies included latest clinical trial and real world data addressing long term safety, long term efficacy in previous inadequate responders, cardiovascular concerns and ‘wearing off’.

Eptinezumab initiated during migraine provides rapid and sustained relief
Starting eptinezumab during a migraine attack results in rapid, sustained freedom from headache pain and most bothersome symptom (MBS), from two hours post-infusion, and decreased need for acute medication within 24 hours.1 It also delays the time to next migraine and provides meaningful improvements in patient-reported and migraine-related impact over the following four weeks.

No safety concerns identified with atogepant over 1 year
Once daily atogepant 60 mg for migraine prevention was safe and well tolerated with no safety concerns identified, according to results of a multicentre open-label trial which included 739 adults with migraine with or without aura in the safety population (n=543 atogepant) (NCT03700320).

Intranasal zavegepant is effective and well tolerated in acute migraine treatment
Zavegepant 10 mg and 20 mg significantly improve freedom from pain and most bothersome symptom (photophobia, phonophobia, or nausea) two hours post-dose in patients with migraine, according to Phase 2/3 data on this intranasal, third-generation, small molecule CGRP antagonist (NCT03872453).

Additional data needed on hypertension risk with anti-CGRP therapies
US migraine specialists are urging further research to fully understand the risk of hypertension in patients treated with erenumab and other anti-CGRP therapies. This follows an analysis of clinical trial and post-marketing data highlighting the limitations of current reports.

Fremanezumab inadequate responders show meaningful efficacy with continued treatment
A substantial proportion of patients who showed an inadequate response to fremanezumab after three months of treatment in the HALO studies of episodic and chronic migraine experienced clinically meaningful reductions in migraine or headache days with longer treatment.

Rimegepant demonstrates favourable safety profile in adults with CV risk factors
Rimegepant 75 mg dosed up to once daily for up to 1 year showed favourable safety and tolerability in adults with migraine with cardiovascular (CV) risk factors, including adults with moderate to high CV risk. In adults with migraine and a history of triptan treatment failure, long-term dosing was also well tolerated.

Ubrogepant safety and efficacy reported at 52 weeks in perimenstrual migraine
Ubrogepant offers comparable efficacy and safety in women with perimenstrual migraine (pmM) to that seen in other patients with migraine, according to data from a Phase 3, open-label, 52-week extension trial of adults with migraine randomised to usual care, ubrogepant 50 mg, or ubrogepant 100 mg.

Post hoc analysis of galcanezumab trials shows low levels of efficacy ‘wearing off’
Low levels of efficacy ‘wearing off’ towards the end of galcanezumab treatment cycles have been reported from a post hoc analysis of data from the EVOLVE-1/2, REGAIN and CONQUER trials.

For all the other recent migraine news featured on the CGRP Forum, catch up at: News

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