Eptinezumab

How it works

It binds to calcitonin gene-related peptide (CGRP) ligand, preventing it from activating its receptor and thereby reducing the neurovascular signalling that drives migraine.

Prescribing in practice

• Hypersensitivity reactions, including anaphylaxis and angioedema, can occur during or shortly after the infusion, so administer where reactions can be managed and observe the patient.
• It is reserved for patients with frequent migraine in whom other preventive treatments have been unsuitable or ineffective, in line with NICE-recommended use.
• Review benefit after an adequate treatment period and stop if there is no worthwhile reduction in migraine frequency.

Monitoring

No routine laboratory monitoring is required, but headache frequency should be tracked to assess response and patients observed for infusion-related reactions.

Counselling the patient

• This treatment aims to reduce how often you get migraines rather than to treat an individual attack.
• Tell the clinician straight away if you develop rash, swelling or breathing difficulty during or after the infusion.
• Keep a headache diary so we can judge whether the treatment is working.

Evidence & guidelines

NICE has appraised CGRP-targeted antibodies for migraine prophylaxis, and pivotal trials demonstrated reductions in monthly migraine days compared with placebo.