On March 10, the United States Food and Drug Administration (FDA) approved a new migraine treatment delivered as a nasal spray, according to the drug’s maker, Pfizer.
Zavegepant (brand name: Zavzpret), is the first in a class of migraine treatments known as calcitonin gene-linked peptide receptor (CGRP) antagonists to be approved as a nasal spray. Until now, these types of drugs were only available in oral and injectable form. In a release announcing the approval, Pfizer says zavegepant will be available in pharmacies in July.
In studies previously released by Pfizer and reviewed by the FDA, zavegepant reduced moderate to severe headaches two hours after people used the spray compared to those who injected a placebo into their nose. Of those who received the spray, 24% reported pain relief after two hours, compared to 15% of those who received the placebo. For some people receiving the drug, relief started as early as 15 minutes after taking the drug.
“With CGRP drugs, scientists have for the first time looked at the pathophysiology of migraine, or what causes migraine, to understand how to modify and alter this process,” says Dr. Kathleen Mullin, Associate Medical Director at New England Institute for Neurology and Headaches, and researcher on one of the zavegepant trials. Experts believe that blocking peptide receptors linked to the calcitonin gene in the brain reduces inflammation linked to migraine pain.
Learn more: 5 ways to deal with migraines at work
Older classes of migraine treatments, such as triptans, work by constricting blood vessels, which is one way to reduce pain in the brain. But such constriction is dangerous for people with heart disease, so the headache population either couldn’t take the medications or had to use suboptimal doses to relieve their migraine pain.
While CGRP antagonists widened the pool of migraine patients who could find relief with medication, they still left out many patients who couldn’t take pills once their headaches started. Many people experience nausea and vomiting during their migraines and cannot take anything by mouth. Additionally, says Mullin, migraines cause slowed movement in the digestive tract, so oral medications aren’t absorbed as quickly and efficiently as they normally would be. A nasal spray works faster and avoids these deterrents.
CGRP antagonist drugs are used to both prevent and treat migraines, but zavegepant is only approved to treat acute migraine pain once an episode begins. For people who have four or more migraines per month, doctors may prescribe an injectable CGRP once a month or every three months. However, for every migraine patient, Mullin says treatment is important because “we know that the more headaches people have, the more headaches they will continue to have. Even if you have a headache every three months, your doctor should prescribe you an acute medication to stop this headache.
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