Richard B. Lipton, MD: CGRP Receptor-Targeting in the Prevention of Migraine

“Two [CGRP-targeting agents] are approved as acute treatments. One of them is rimegepant. The other is ubrogepant… Rimegepant and ubrogepent had been acute treatment only, taken orally. What they have in common is that they all target CGRP in different ways, and therefore... are specific to what we've learned about the fundamental biology of migraine.”

Rimegepant (Nurtec; Biohaven), a calcitonin gene-related peptide (CGRP) receptor antagonist, was approved for the acute treatment of migraine in February 2020.¹ A recent multicenter, phase 2/3, randomized, double-blind, placebo-controlled trial (NCT03732638) showed that rimegepant is also effective in migraine prevention when taken every other day (QOD) and is well-tolerated in patients with the headache disorder.²

NeurologyLive spoke with study co-author Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, to learn more about the current landscape of migraine treatment.

Lipton discussed monoclonal antibody injections and oral medications that target CGRP receptors that are currently FDA approved. Rimegepant, the medication that his team investigated, and ubrogepant, are oral medications approved for acute treatment of migraine, while only monoclonal antibody injections are currently approved for prevention of migraine.

REFERENCES

1. Rimegepant Approved by FDA for the Acute Treatment of Migraine in Adults. News release. Biohaven Pharmaceuticals. February 27, 2020. Accessed January 6, 2021. https://americanheadachesociety.org/news/rimegepant-acute-migraine-treatment/
2. Kroop R, Lipton RB, Kudrow D, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet Neurol. Published online December 15, 2020. doi: 10.1016/S0140-6736(20)32544-7