Antibodies as Treatment for Chronic Pain and Migraine

 By Egilius L.H. Spierings, M.D., Ph.D.

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Antibodies help our body in an extremely targeted way to fight infections, such as with viruses or bacteria. They are formed by the immune system to specifically attack an invader, whatever it is. With vaccinations, the antibodies are formed to prevent specific viral or bacterial infections. Antibodies are also involved in allergies and allergic reactions as well as in so-called autoimmune diseases. What is new, however, is that they are now also being used as medications for non-infectious illnesses, in this particular case, chronic pain and migraine.Since about a decade, MedVadis Research has been involved in testing specific antibodies as treatment for chronic pain and migraine. As antibodies are proteins, they cannot be taken by mouth because the stomach would digest them. They have to be given by injection, which is generally an injection into the skin called subcutaneous injection. These injections are given anywhere from once every month to once every quarter. They can be given relatively infrequently because the antibodies last long.

For the treatment of chronic pain, the antibodies specifically target a chemical in the body called nerve growth factor or NGF. It is not known what NGF exactly does but in some way it’s involved in pain and blocking it, as the antibody does, provides pain relief. We have studied the Pfizer NGF antibody called tanezumab for chronic low-back pain and osteoarthritis hip and knee pain. The medication looks promising but it’s still too early to tell how effective it is and whether there are particular safety concerns. The same is true for the NGF antibody in development by Regeneron called fasinumab.

More is already known about the antibodies in development for the treatment of migraine. There are four and their names are: eptinezumab, erenumab, fremanezumab, and galcanezumab. They are specifically developed to target CGRP, which stands for calcitonin gene-related protein. CGRP is the chemical in the body that opens up the blood vessels in the head to cause the migraine headache. The antibodies prevent the CGRP from working and, hence, prevent the occurrence of migraine.

The CGRP antibodies are very well tolerated and people generally have no side effects at all. Also, their safety looks very good. They are used for episodic and chronic migraine and are generally given by injection once per month. In terms of reducing migraine headache days, about 60% of people obtain at least a 50% reduction. As much as one-third may experience a reduction in migraine headache days of 75% or more. In addition, there is a small group of 10-15% with total relief from migraine. Altogether these are very promising results.

MedVadis Research is currently conducting studies with the CGRP antibody knowns as fremanezumab. Two studies are open for enrollment. One of the studies is for people with episodic or chronic migraine, who have tried and failed at least two preventive medications. They can have failed these medications because of lack of significant benefit, intolerable side effects, or contraindications. The other study is for people with persistent headaches following a head or neck injury. The headaches do not have to be diagnosed as migraine. Feel free to call us at 617-744-1310 or contact us by email (Spierings@MedVadis.com) for questions or concerns regarding these two studies. We appreciate your interest and look forward to hearing from you!