New Migraine Drug

Emgality is one of the new injectable migraine drugs with high potential. It serves as a calcitonin gene-related peptide (CGRP) antagonist. CGRP is a neuropeptide and one of its functions is mediating vasodilation. The full physiology and mechanism of migraines are poorly understood but one factor thought to contribute is vasodilation. This is what makes emgality play a new role in migraine medications that have not yet been explored when it blocks CGRP it also inhibits vasodilation. In clinical trials, up to 62% of patients had a greater than 50% reduction in their monthly migraines. Emgality is a self-administered subcutaneous injection, there is an initial loading dose of 240mg and then every month after that it is one shot of 120mg. This serves as a once-monthly solution to at least decrease the number of migraines for someone who experiences them chronically.

The caveat to this new and interesting migraine medication is the fact that we do not understand fully what CGRP does. This protein is found in the central and peripheral nervous system, it is co-expressed with ACh in motor neurons and there is a possibility that it is involved in the synthesis of acetylcholine. We know that it plays a big role in vasodilation, but we are not sure how much it truly affects the cardiovascular system. Emgality currently has been through two 6-month trails that show promise but we have no clue about the long-term effects. Is it ethical to approve and prescribe a drug that shows promise but the widespread effects of CGRP antagonists are still very much unknown? Should patients just be warned, and it left as their decision or should there be more long-term research completed first?

“For Healthcare Professionals: Emgality® (Galcanezumab-Gnlm).” For Healthcare Professionals | Emgality® (Galcanezumab-Gnlm), https://www.emgality.com/hcp.

Russell, F A, et al. “Calcitonin Gene-Related Peptide: Physiology and Pathophysiology.” Physiological Reviews, American Physiological Society, Oct. 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187032/.

Jacobs, Blaine, and Gregory Dussor. “Neurovascular Contributions to Migraine: Moving beyond Vasodilation.” Neuroscience, U.S. National Library of Medicine, 3 Dec. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083225/.

Russell, F A, et al. “Calcitonin Gene-Related Peptide: Physiology and Pathophysiology.” Physiological Reviews, American Physiological Society, Oct. 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187032/.