By Annerose Fischer-Bucher
Since the middle of the year, new preparations for chronic migraine have come on the market, which are mainly offered by three companies in Germany. Among them is a new group of drugs for the treatment of chronic migraine. What's up with a newly approved biotech drug? Andrea Nägele, Senior Consultant of the Neurological Clinic in Göppinger Christophsbad.What is a migraine? Andrea Nägele: A migraine is a violent attacks of attacks, usually one-sided, pulsating headache, which is accompanied by nausea and vomiting. It can take between 4 and 72 hours. In contrast to tension headache, it increases during physical activity. Photophobia, noise and odor sensitivity are other accompanying symptoms. Since there are many types of headache, not every headache, as popularly called, is a migraine. What types of migraine are there? We distinguish acute and chronic forms of migraine with some characteristic subtypes, for example, the familial form associated with associated with hemiplegia. Chronic migraine is defined as a headache lasting more than 15 days per month.What does aura mean? These are symptoms of 5 to 20 minutes even before headaches occur. This can be visual disturbances in the form of flickering lights, points, lines or even numbness and tingling sensations, which then follow the headache. The migraine with aura accounts for about 10 to 15 percent, without aura about 85 percent. How large is the percentage of headache patients in your clinic? About 15 to 20 percent of our patients come to us with the headache symptom. Headache can be a concomitant symptom of many neurological conditions such as cerebral hemorrhage, meningitis, sleep apnea syndrome, or tension-type headache caused by muscular tension. Our daily work and expertise is to identify the type of headache and treat it specifically. What is the treatment for chronic migraine? So far, there were for this group of patients as a prophylactic prophylactic beta blocker, antidepressants, botulinum toxin and drugs for epilepsy, which Frequency of headache days. Only about 20 percent of patients remained on these therapies. Most have to discontinue the medication because of the side effects. A prescription drug made from bio-engineered antibodies has been approved by the EMA (European Medicines Agency) since July 2018. How it works The new medication for chronic migraine is called Erenumab. It blocks the CGRP receptor (calcium gene-related peptides). CGRP is released as a messenger in the meninges. The exact function is not yet known. However, CGRP is known to over-sensitize nerves, dilate blood vessels and affect pain processing.How do you rate success? According to the studies, patients with high levels of CGRP benefit most from this new drug. The number of headache days decreased by half in this patient group. Erenumab is injected under the skin once a month. Side effects include mild redness at the injection site and mild constipation. Do you use the new biotech drug? Natural. The patients have a high level of suffering and a significantly reduced quality of life due to the high number of headache days. Erenumab is so far the only drug approved in Germany. Fremanezumab, galcanezumab and eptinezumab are likely to follow. What is the difference between
In a biopharmaceutical, biotechnology agents use genetically engineered organisms that produce proteins or nucleic acids. They can be programmed to dock to specific cells in the body, and are therefore highly efficient and more selective than chemical molecules. So far, such drugs are already used in cancer therapy. Biotech drugs are complex to produce and expensive. Will such a drug be available for cash-desk patients? If a patient is in the indication group, the health insurance pays. The cost is about 6000 euros per year. I suspect that due to the high cost, the reimbursement will be made outside budgeting.