Professor Christian Lampl
The CGRP-targeted migraine prophylaxis treatment galcanezumab (Emgality) is being made available on private prescription for under $300 a month while it awaits PBS listing, according to Eli Lilly.
Via the manufacturer’s Ember program neurologists will be able to prescribe the first two monthly subcutaneous injections of galcanezumab free for enrolled patients from October 2019, and with ongoing supply at a recommended retail price of $297 per month.
The monoclonal antibody biologic was recommended for PBS listing by the Pharmaceutical Benefits Advisory Committee (PBAC) at its July meeting, but has yet to have a date announced for when it will be subsidised. The PBAC recommendation was for PBS subsidy for people with chronic migraine who have 15 or more headache days per month (8 of which are migraine) and who have experienced an inadequate response, intolerance or a contraindication to at least three prophylactic migraine medications.
On a speaking tour of Australia sponsored by Eli Lilly, the vice president of the European Headache Federation, Professor Christian Lampl said experience with the CGRP targeted therapy was that it could reduce migraine intensity and frequency by about a third.
Speaking to the limbic, he said his personal experience with galcanezumab was that patients would see effects in the first month after he started them on a double dose.
And in contrast to other migraine prophylaxis treatments such as beta blockers and topiramate the CGRP treatment was well tolerated and had few side effects other than typical injection site reactions.
“So it’s not a cure for migraine but we can explain to patients that it will reduce the number of migraine headache days by about five days per month,” said Professor Lampl, Director of the Headache Medical Center Linz, Austria.
He said the CGRP-targeted monoclonal antibody therapies appeared safe and did not have the liver toxicity seen in trials with early CGRP peptide-based therapies.
And while reimbursement was confined to patients with high frequency migraines, he suggested there was a role for the drugs in patients with more than six migraine headache days per month, to avoid progression to chronic migraine.
Galcanezumab is the first of three CGRP targeted therapies to be recommended by the PBAC. Erenumab (Aimovig) has been rejected rejected twice by the PBAC and is on the agenda for a third time at the November PBAC meeting, along with a first time application for fremanezumab (Ajovy).
Aimovig is currently available on private prescription from Novartis at a cost of about $750 per script.