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  • Alternative CGRP Option for Migraineurs
    Patients diagnosed with chronic migraines are likely all too familiar with the potentially disabling characteristics of the condition. The newest class of migraine medications, calcitonin gene-related peptide (CGRP) receptor antagonists, are helping answer the call for acute treatments that can effectively counter migraine attacks. A recent approval for a CGRP receptor antagonist delivered through a new method may be a helpful alternative, especially for patients who cannot tolerate other drug forms.

    With over 39 million individuals in the US and over one billion individuals globally affected by migraines, the disease ranks as the third top worldwide illness. Patients with migraines often must cope with intense, throbbing head pain lasting for hours or several days. Additional symptoms can accompany the pain of an attack, commonly nausea, vomiting, light or sound sensitivity, and visual disturbances known as auras. Quality of life for these patients can be strongly diminished. The treatment plan a provider determines will usually be based on the frequency and severity of the headaches, if any additional symptoms occur, and any other medical conditions the individual has. Mild-to-moderate migraine attacks are typically addressed with analgesics such as acetaminophen and NSAIDs. Moderate-to-severe attacks are managed with migraine-specific treatment, including oral triptans. Triptans result in the constriction of blood vessels. They are sometimes not tolerated by individuals and should be avoided in those with a medical history of, or who are at risk for, stroke, artery disease, or cardiovascular disease.

    In March 2023, a new approval was granted in the CGRP receptor antagonist drug class, which can give a promising alternative for migraine patients. The CGRP pathway has been targeted as having a significant role as a source for migraine pain. Research has discovered elevated CGRP levels in patient blood serum during and between migraine attacks, appearing in plasma, saliva, and tears. Medications that act on CGRP receptors are effective for treating migraine, and the newest approval provides a quick and reliable delivery method for such an antagonist. Zavzpret (zavegepant) has been approved for the acute treatment of migraine with or without aura in adults. Zavzpret is not indicated for the preventive treatment of migraine. Its recommended dose is 10mg as a single spray in one nostril, as needed, with one dose being the maximum for a 24-hour period.

    Zavzpret offers some unique differentiators from other medications used to treat migraine. It does not have the complication of cardiovascular risk that triptans do, making it a favorable alternative for certain patients who cannot take triptans. Another desirable feature is that it is dispensed as a nasal spray. Sprays can be absorbed faster by the body, bringing the beneficial effect of the medication to patients more quickly. Clinical trials for Zavzpret showed its ability to reduce the pain from migraine attacks in 15 minutes. Since many migraine patients experience nausea and vomiting along with their attacks, having access to a non-oral medication can be a relief. Gastroparesis is also known to be present in migraine patients. Hence, the nasal spray dispensing of Zavzpret is favorable as it allows for quicker absorption of the drug, which is especially helpful for patients who may have slowed gut function.

    Although there is no cure for migraines, new therapies such as Zavzpret continue to emerge that are helpful new additions to the existing options for migraine management. Hopefully, as advancements in migraine therapies continue, patients will experience less debilitating and less frequent migraines, and consequently, the quality of their lives will improve. Stay informed about emergent drug information, including treatment options for migraine, by updating or registering your profile to receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app, mobilePDR, available for free from your favorite app stores.