Dearest migraines

Anne Ducros is a neurologist at Montpellier University Hospital. A migraine specialist, she assists patients who are often confronted with the ineffectiveness of current medications. A new antibody treatment does exist, but it's not yet on the market in France. The reason? It's too expensive.

15% of French people suffer from migraines. This complex neurological disease is still poorly understood, involving at least forty genes. For 1% of patients, it takes on a severe chronic form. These headache attacks occur for more than a fortnight a month and, in addition to intense pain, cause intolerance to noise and light, nausea and vomiting, which are not always relieved by current medication. But a new treatment could change the lives of thousands of people.

A first specific treatment

A new therapeutic class specially designed for migraine. A first. Until now," explains Anne Ducros, neurologist at Montpellier University Hospital and university professor, " we've only had non-specific treatments. We still treat migraine sufferers with anti-hypertensives, anti-epileptics or anti-depressants, even though they are neither hypertensive, epileptic nor depressed". These treatments can reduce cerebral excitability and thus the risk of migraine, but they expose patients to frequent and serious side-effects such as drowsiness, impaired concentration, fatigue, shortness of breath...

In recent years, however, research has identified the role of a mini-protein, CGRP. "A small peptide released at the time of attacks by a nerve called the trigeminal nerve, which causes vessels to dilate and a cascade of events leading to pain", describes Anne Ducros. The researchers then went on to develop antibodies capable of targeting and blocking CGRP, and thus putting an end to migraine.

To date, four antibodies targeting either CGRP or its receptor have passed clinical trials in patients not responding to conventional treatments. "At least half of the patients have seen a 50% reduction in their attacks, and some have virtually no attacks at all. And those who didn't improve with one type of antibody may well respond to another," explains the neurologist.

No side effects

Above all, this treatment has no side effects, apart from "a little pain at the injection site in some people". This is because, unlike current disease-modifying therapies, which are taken daily in the form of oral tablets, these antibodies are administered as a simple monthly injection.

As Anne Ducros points out: "Studies show that after one year, 80% of patients with chronic migraines are still taking their treatment, whereas with conventional background treatments, 80% stop.

These results enabled the antibody treatments to gain approval from theEuropean Medicines Agency and the Food and Drug Administration, its American equivalent. When they were submitted to the French authorities, they did give approval in the treatment of severe migraine, but "they considered that there was no improvement in the medical service rendered, so they are asking for further studies to show superiority to current treatments." This makes it impossible to release the drug in 2019... So when? Nobody knows.

In the light of published studies, this decision is incomprehensible to the specialist. "Some of my patients who don't respond to conventional treatments have been waiting a long time. When I tell them they'll have to wait even longer, they feel it's a real injustice."

550 euros per injection

This injustice is compounded by the fact that the main obstacle to bringing this new drug to market is its price: 550 euros per injection in the USA and Switzerland. This high cost is partly due to the length of the manufacturing process. " It takes five years to develop an antibody production plant capable of producing a stable, pure and effective therapeutic product," explains Anne Ducros.

Today, while French doctors can prescribe these treatments to their patients, the latter have to travel to Switzerland to buy them. " For six injections, they pay 3,200 euros, so for those who can afford it, it works, but for the others... It's a real two-tier medicine," observes the neurologist. Before concluding with a wish, not so pious: "There is probably room for innovation to succeed in producing antibodies more cheaply... For medium-profit companies."