A new option for patients with treatment-resistant migraine

In The Lancet Neurology, Messoud Ashina and colleagues report the results of DELIVER, a randomised, multi-arm, double-blind, placebo-controlled trial of eptinezumab for the prevention of migraine.1 The study included participants with two-to-four migraine preventive treatment failures, similar to pa...

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Bibliographic Details
Published in:Lancet neurology 2022-07, Vol.21 (7), p.578-579
Main Authors: Ornello, Raffaele, Sacco, Simona
Format: Article
Language:English
Subjects:
Calcitonin gene-related peptide
Clinical medicine
Clinical trials
Drug development
Drug therapy
Headache
Migraine
Monoclonal antibodies
Prevention
Therapeutic targets
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Summary:In The Lancet Neurology, Messoud Ashina and colleagues report the results of DELIVER, a randomised, multi-arm, double-blind, placebo-controlled trial of eptinezumab for the prevention of migraine.1 The study included participants with two-to-four migraine preventive treatment failures, similar to participants in the LIBERTY (erenumab),2 FOCUS (fremanezumab),3 and CONQUER (galcanezumab)4 trials. The drugs’ specific mechanism of action, quality of supporting evidence, efficacy and tolerability profile, and user satisfaction might be expected to place anti-CGRP monoclonal antibodies among first-line treatment options, as also suggested by the European Headache Federation;6 however, in many countries, anti-CGRP monoclonal antibodies are not reimbursed as first-line treatments because of high direct costs. In clinical practice, some non-responders to anti-CGRP monoclonal antibodies have already tried and not responded to all the available therapeutic options and their migraine can be considered refractory, with no viable management strategy.5,8 In that population, it will be interesting to investigate the role of combined prevention and non-pharmacological treatments, to better understand the mechanisms underlying the lack of response, and to find therapeutic targets other than CGRP.
ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(22)00222-8