New CGRP Drug Tastes Success In Last Stage Clinical Trials, To Hit Markets Soon

Stressed Woman.jpg

New Drug Can Stop A Migraine From Occurring (1)

The role of CGRP or Calcitonin Gene-related Peptide has been implicated in migraine research since 3 decades now. However, the exact nuisances to trace the working of CGRP and then tame it’s effects during a migraine attack was being studied and at times led to hopes for migraineurs but further tests on those hypotheses on which some of the drugs worked, failed.

CGRP is basically a neurotransmitter that is produced by cells in our central nervous system (CNS) and also by peripheral neurons. As the name suggests, it is a peptide or a chain wherein several amino acid molecules are linked to each other. CGRP’s main function is to cause vasodilatation or swelling of cranial arteries and cranial membrane, and transmission of pain. (2)

When CGRP is released by the CNS neurons into our blood, it is affected by two types of receptors: Calcitonin receptor-like receptor (CALCRL) and, a receptor activity-modifying protein (RAMP1).

Over the years drugs have been made to block these receptors during a migraine episode with new drugs but they have been found to be too toxic for the human liver. Currently, a few pharmaceutical corporations such as Amgen/Novartis, Teva and Eli Lilly are in the brink of bringing revolutionary CGRP drugs that work for us without unleashing a series of serious side effects.

Based on the data obtained on its 2 successful phases of trials of their new drug (galcanezumab), Eli Lilly concluded that in episodic and chronic migraine, a 50% reduction was seen in around 60% of patients on galcanezumab versus 36%-39% of placebo users, with all migraine attacks eliminated in 12%-15% and 6%, respectively.

As per the Christi Shaw, President at Lilly Bio-Medicines, “the findings are a crucial step forward for the millions of patients living with migraine that have not yet tried, or found, an effective preventive therapy.” (3)

At the moment, Lilly is trying to differentiate galcanezumab with the drugs from the pharma companies who are in the run for licenses to sell, on the basis of its Phase III program in cluster headaches which is due to read out next year, and has said it hopes galcanezumab will be the first drug in its class with pivotal data in this indication.

As per Peter Goadsby, neurologist at King’s College London an UCSF is of the opinion that, “We’re in a genuine watershed moment with the very first class of migraine treatments that can prevent the attacks from actually happening. It’s incredibly encouraging and provides much needed hope to people who continue to struggle despite a range of currently available treatments.” (4) He noted this of all the CGRP-based therapies by the different pahrma companies that were possibly to hit the market.

In the meanwhile, Lilly has acquired CoLucid with it’s lead drug lasmiditan. Lasmiditan is to arrive in 2018 as an orally taken 5-HT 1F receptor agonist against acute migraine attacks. Data reported on this drug have been favourable and were reported at the AHS meeting. It was noted that significantly more participants were free of headache pain and other symptoms such as nausea, or aversion to loud sounds or light two hours after treatment with lasmiditan, compared to placebo.

SOURCES:

  1. Picture Credit: FreeDigitalPhotos; “Stressed Businesswoman” by Ambro; http://www.freedigitalphotos.net/images/agree-terms.php
  2. Calcitonin Gene-related Peptide; Wikipedia; https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptide
  3. Lilly’s CGRP Inhibitor Galcanezumab Hits The Mark In Migraines As Race To Market Kicks Off; Fierce Biotech; Phil Taylor; June 2017; http://www.fiercebiotech.com/biotech/lilly-s-cgrp-inhibitor-galcanezumab-hits-mark-migraine-as-race-to-market-kicks-off
  4. AHS Meeting Release CGRP; 59th Annual Scientific Meeting; https://americanheadachesociety.org/ahs-meeting-release-cgrp/

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Green Light To Milder Migraine Pain

gREEN BEAM

There is hope yet for migraineurs. If science cannot do away with migraines altogether, the word is out that you can at least have lower intensity pain episodes than what you experience in your migraine episode.

Tests were conducted by Dr Rajesh Khanna. a professor of pharmacology at the University of Arizona and Dr. Mohab Ibrahim, director of the Chronic Pain Clinic and Chronic Pain Fellowship at Banner-University Medical Center.

The tests were initially run on rats with significant results and then they were extended to pain patients who were subjected to 2 hours a day of green light for a period of 10 weeks. Some other pain patients were exposed to a similar period of white light.  The green light group said their pain from migraine and fibromyalgia dropped 40 to 50 percent.

As per Dr. Khanna, “At a chemical, a neurochemical level, it does something to tune the system, so essentially what it’s doing is increasing your happy hormones, your level of endogenous opioids.” (1)

Ibrahim and Khanna hope to get grants from the Department of Defense and the NIH so they can expand the study. They also caution people not to give up their pain medication. A detailed report along with the findings can be viewed here: http://ow.ly/qtKl30efr3k

Results of a similar study were published in Brain last year in May. A group of scientists at Harvard Medical School had conducted those tests.

In a migraine attack, the migraineurs experiences not just incapacitating pain, but also develop aversion to light and sound as well as array of other symptoms like nausea, visual and motor impairment. Aversion to light or photophobia during a migraine episode affects 80% of all migraineurs.

The study showed that a narrow band of green light at low intensity reduces the intensity of the pain being experienced. Burstein, Professor of Anesthesia at Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, and lead author of the study, and his colleagues found, unexpectedly, that green light actually reduced their pain by about 20%. (2)

Bands of light in other colors and higher intensity lights including green actually pegged up the pain experience.

To be able to comprehend this phenomenon, the scientists devised experiments in which they measured the magnitude of the electrical signals generated by the retina (in the eye) and the cortex (in the brain) of these patients in response to each colour of light. They found that green light generated the smallest electrical signals in both the retina and cortex.

SOURCES:

1.     Health Beat: Green light for pain relief: Migraines; Melanie Falcon, August 7, 2017; http://www.wfmz.com/health/health-beat/health-beat-green-light-for-pain-relief-migraines/601026622
2.     Science Daily: A narrow band of green light could improve migraines; May 17, 2016; https://www.sciencedaily.com/releases/2016/05/160517083042.htm

JOURNAL REFERENCE:

Rodrigo Noseda, Carolyn A. Bernstein, Rony-Reuven Nir, Alice J. Lee, Anne B. Fulton, Suzanne M. Bertisch, Alexandra Hovaguimian, Dean M. Cestari, Rodrigo Saavedra-Walker, David Borsook, Bruce L. Doran, Catherine Buettner, Rami Burstein. Migraine photophobia originating in cone-driven retinal pathways. Brain, 2016 DOI: 10.1093/brain/aww119

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New Beginnings, New Year

HAPPY NEW YEAR 2016

As 2015 draws to a close, I hope for the readers that this year was blessed with happy memories and useful learnings. As 2016 stands at our threshold, I wish for each one of us, a very very Happy New Year. Hoping we all dive into 2016 full of enthusiasm and positivity. #2016

Image credit: Happy New Year 2016 Card. Colorful Snow In Winter On Blue Sky Background By Tanya3597 on freedigitalphotos.net

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Migraineurs Twice More At Risk Of Depression & Suicidal Thoughts

Depression & Migraines

Young Migraineurs Twice Likely To Be Depressed Than Those Healthy (1)

A large-scale study conducted in Canada by researchers from University of Toronto’s Factor-Inwentash Faculty of Social Work on 67,000 persons has now concluded that women under 30 years of age were six times more likely to have migraines co-morbid with depressive states than women older than 65 years of age. The paper which was published in the journal Depression Research and Treatment also stated that the prevalence of depression among those with migraine whether women or men are approximately twice as high as for those without the disease. The findings for depression rates in migraineurs and healthy persons were:

Gender Particular: Depression

Prevalence %

Women With Migraines

12.4

Women Without Migraines

5.7

Men With Migraines

8.4

Men Without Migraines

3.4

 

 The study analysed data which re-validated old truths about gender bias of the disease: that 1 in every 7 women had migraines compared to 1 in every 16 for men.

On similar lines were thoughts on suicide. Those under 30 years of age were four times more likely than those over 65, to consider suicide as a result of debilitating and repetitive migraine episodes. A glance at the findings for seriously contemplating suicide at least once between men and women both with and without migraines:

Gender Particular: Suicidal Thoughts

Prevalence %

Women With Migraines

17.6

Women Without Migraines

9.1

Men With Migraines

15.6

Men Without Migraines

7.9

According to Meghan Schrumm, “We are not sure why younger migraineurs have such a high likelihood of depression and suicidal ideation. It may be that younger people with migraines have not yet managed to find adequate treatment or develop coping mechanisms to minimize pain and the impact of this chronic illness on the rest of their lives. The much lower prevalence of depression and suicidal ideation among older migraineurs suggests a promising area for future research.” (2)

Co-author and researcher Dr. Fuller Thomson states that, “This study draws further attention to the need for routine screening and targeted interventions for depression and suicidality, particularly among the most vulnerable migraineurs: Individuals who are young, unmarried and those with activity limitations.” (3)

SOURCES

  1. Image Credits: Depressed Woman Sitting On Floor ” by David Castillo Dominici; FreeDigitialPhotos.net; Web October 2013; http://www.freedigitalphotos.net/images/agree-terms.php?id=10099322
  2. Migraine sufferers more likely to have depression; Medical News Today; Web October 2013; http://www.medicalnewstoday.com/articles/267610.php
  3. Depression Twice as Likely in Migraine Sufferers; Science Daily News; Web October 2013; http://www.sciencedaily.com/releases/2013/10/131017114231.htm

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Migraines & Other Pains Express Themselves In Stressed Middle-Aged Women

Middle Age Migraine

 

 

Pain Symptoms Reveal Themselves Especially in Stressed Middle-Aged Women (1)

Turns out that stress is more than just a migraine trigger. If the recent study conducted by the University of Gothenburg, Sweden is to be believed then almost half the women who suffer from long-term stress will suffer from some pain symptoms, migraine being one of them. They may also suffer from frequent headaches and psychosomatic symptoms such as gastrointestinal disorders

The research done by the Sahlgrenska Academy pursued 1500 women from 1968. It noted that stress experienced by women was the highest between the years 40 and 60. It was also observed that the most stressed of these women were mainly those who smoked and/or those who were single.

The statistics revealed the following in the women who were stressed:

Category/Pain Type  Body Percentage
Psychosomatic symptoms Aches, Pains of muscles and joints

40

Neurological Migraines, (and headaches)

28

Gastrointestinal symptoms IBS, flatulence, bloating

28

 

 According to Dominique Hange from the Academy, “Even when the results have been adjusted for smoking, BMI and physical activity, we can see a clear link between perceived stress and an increased incidence of psychosomatic symptoms. Of course, since 1968, women’s lifestyles have changed in many ways. For example, many more women now work outside the home. Naturally, these changes can affect the experience of stress. But although we’ve used exactly the same question ever since 1968, we can’t take it for granted that the term ‘stress’ has exactly the same meaning today. It might also be more socially accepted today to acknowledge one’s experience of stress.” (2)

The more important conclusion of the study was that women who stay at home single and smoke were most vulnerable to stress and required the maximum need for preventative measures from both  primary healthcare and the society. This would go a long way to tackle stress-related illnesses among women starting when they are still young.

 

SOURCES:

  1. Image Credits: FreeDigitalPhotos.net; David Castillo Dominici; Web June 2013; http://www.freedigitalphotos.net/images/Emotions_g96-Screaming_Woman_p59454.html
  2. Physical Symptoms Often Manifest In Stressed Middle-Aged Women; Medical News Today; Web June 2013; http://www.medicalnewstoday.com/releases/261399.php

 

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New Biomarker Predicts The Severity Of A Migraine Episode

Biomarkers Migraine

Adiponectin Levels In Blood Signal Pain Severity In Migraines During An Attack (1)

Adiponectin is a protein hormone that is secreted by fat or adipose tissues into our bloodstream. It is known to modulate many metabolic processes (such as glucose flux, insulin sensitivity, fatty acid oxidation, weight loss, regulation of energy metabolism etc) as well as immunity and inflammation attributes. Adiponectin is also known to modulate several of the pain pathways implicated in migraines.

A recent small-scale study on migraineurs who had anything between 2-12 episodes a month, was conducted by the Johns Hopkins University School of Medicine has now revealed that measuring the levels of adiponectin or ADP before a migraine treatment can tell which patients found relief from the debilitating pain. The study examined 20 women for a three-year period (2009-2012)

According to the associate professor of neurology and director of headache research at the Johns Hopkins University School of Medicine, B. Lee Peterlin, D.O, “This study takes the first steps in identifying a potential biomarker for migraine that predicts treatment response and, we hope, can one day be used as a target for developing new and better migraine therapies.” (2)

The process included a taking blood samples of women (to check ADP levels) before giving them either a sumatriptan/naproxen or a placebo dosage and then re-drawing blood from them at half an hour, an hour and after two hours of the drug/placebo administration.

Levels of both types of ADP, viz Low Molecular Weight (or LMW, having anti-inflammatory properties) and High Molecular Weight (or HMW, having pro-inflammatory properties) were assessed.

The researchers found that higher LMW counts caused a decrease in pain for the migraineurs and a higher ratio of HMW: LMW caused pain aggravation. It was also noticed that patients who received a steady treatment for the migraine irrespective of the fact that they were being dosed with a drug or a placebo showed an overall decrease in the total ADP over a period of time.

In Peterlin’s view, should ADP (LMW and HMW) be proved to be a biomarker for migraine pain with larger scale studies, it would be very helpful for physicians to know which migraineur would benefit from which type of treatment and help them try out alternative drugs sooner than later.

The study was supported by a grant from GlaxoSmithKline and from the National Institutes of Health’s National Institute of Neurological Disorders and Stroke.

SOURCES:

  1. Image Credits: FreeDigitalPhotos.Net; Victor Habbick; Web June 2013; http://www.freedigitalphotos.net/images/agree-terms.php
  2. Blood Levels of Fat Cell Hormone May Predict Severity of Migraines; ScienceDaily News; Web June 2013; http://www.sciencedaily.com/releases/2013/03/130318131205.htm

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