Dealing with the debilitating pain and disruption of migraine attacks can significantly impact quality of life.

For many individuals in the US who experience frequent migraines, traditional acute treatments only offer temporary relief. This has led to a growing focus on preventative therapies, with breakthroughs like Eptinezumab (brand name Vyepti®) offering new hope.

Designed specifically for the prevention of migraine in adults, Eptinezumab represents a significant advancement in managing this complex neurological condition.

Eptinezumab, marketed as Vyepti, belongs to a class of medications known as Calcitonin Gene-Related Peptide (CGRP) inhibitors. CGRP is a protein found in the body that is believed to play a crucial role in triggering migraine attacks. During a migraine, CGRP is released and can cause blood vessels around the brain to enlarge and become inflamed, leading to the characteristic pain.

 

 

How Eptinezumab Works: Vyepti is a humanized monoclonal antibody that works by binding directly to the CGRP ligand (the protein itself), preventing it from attaching to its receptors. By blocking this binding, Eptinezumab helps to stop the migraine process before it even starts, thereby reducing the frequency and severity of migraine attacks.

 

The Unique Advantage: IV Infusion for Fast & Sustained Relief

Unlike other CGRP inhibitors that are self-administered via subcutaneous (under-the-skin) injections, Eptinezumab stands out as the first and only FDA-approved intravenous (IV) preventive migraine treatment for adults.

 

• Rapid Onset of Action: Because it's administered directly into the bloodstream via an IV infusion, Eptinezumab reaches its maximal blood level very quickly – typically within 30 minutes of the infusion's completion. Clinical trials have shown that patients experienced a significant reduction in migraine days within the first 24 hours of receiving the infusion.

   

   

  
  


• Sustained Prevention: A single infusion is designed to provide sustained migraine prevention for three months (12 weeks). This means patients only need to receive treatment four times a year.
  

   

  
  


• Convenience: For some patients, the convenience of a quarterly IV infusion administered by a healthcare professional may be preferable to more frequent self-injections.

Who is Eptinezumab For?

Eptinezumab is indicated for the preventive treatment of migraine in adults who experience:

• Chronic Migraine: Defined as having 15 or more headache days per month, with at least 8 of those being migraine days.


• Episodic Migraine: Defined as having fewer than 15 headache days per month.
  

   

  
  

It is particularly relevant for individuals who have tried other preventive treatments without sufficient success or who prefer the consistent delivery of an IV infusion.

Clinical Trial Results: Efficacy and Patient Outcomes

Clinical trials (PROMISE 1 for episodic migraine and PROMISE 2 for chronic migraine) demonstrated Eptinezumab's effectiveness:

 

• Reduced Migraine Days: Patients experienced a significant reduction in monthly migraine days (MMDs) compared to placebo. For chronic migraine, patients on Vyepti 100 mg had, on average, 7.7 fewer MMDs over months 1-3. Forepisodic migraine, the reduction was about 3.9 MMDs.

   

  
  


• High Responder Rates: A notable percentage of patients achieved a 50% or even 75% reduction in their MMDs.
  

   

  
  


• Sustained Benefit: The preventive benefits were sustained over multiple doses (up to six months and even up to 18 months in extension studies), indicating long-term effectiveness.
  

   

  
  


• Reduced Acute Medication Use: Patients often reported needing fewer medications to treat acute migraine attacks.
  

   

  
  


• Improved Quality of Life: Many patients reported better overall functioning, reduced disability, and improved satisfaction with daily living after starting Eptinezumab.
  

   

  
  

Important Safety Information & Side Effects

Like all medications, Eptinezumab can cause side effects. The most common side effects reported in clinical trials (occurring in at least 2% of patients and more often than placebo) include:

 

• Nasopharyngitis (common cold symptoms like stuffy nose, sore throat)


• Hypersensitivity reactions (allergic reactions), which can include rash, swelling of the face, lips, tongue, or throat, hives, or trouble breathing. Serious allergic reactions, including anaphylaxis, have been reported and can develop within minutes of the infusion, requiring immediate medical attention.
  

   

   

  
  


• Fatigue


• Infusion-related reactions (e.g., irritation at the infusion site)

It's also important to note that high blood pressure or worsening of pre-existing high blood pressure, and worsening or new onset of Raynaud's phenomenon (a circulation problem causing fingers/toes to feel numb, cool, or change color) have been reported after receiving Vyepti and similar drugs.

 

Always discuss potential risks and benefits with your healthcare provider. They will assess your individual medical history and determine if Eptinezumab is a suitable treatment option for you.

Cost and Insurance Coverage in the US

The annual cost of Eptinezumab (Vyepti) in the US can range from approximately $7,240 (for the 100 mg dose) to $21,720 (for the 300 mg dose) based on publicly available prices (as of late 2023). This makes it comparable to or slightly higher than other CGRP monoclonal antibodies.

 

Most health insurance plans in the US are likely to cover Eptinezumab for eligible patients, especially if they have tried other preventive treatments without success. However, coverage varies significantly based on your specific insurance plan, deductible, co-pay, and any prior authorization requirements. It's essential to:

• Contact your insurance provider directly to understand your benefits and coverage for Vyepti.


• Inquire about patient assistance programs offered by the manufacturer (Lundbeck) or other organizations, which can help reduce out-of-pocket costs.
  

   

  
  

The Future of Migraine Prevention

Eptinezumab offers a compelling option for many adults in the US seeking long-term, effective prevention from debilitating migraines. Its rapid action and quarterly IV administration provide a unique treatment profile within the growing class of CGRP inhibitors. If you experience frequent migraines and are looking for a new approach to prevention, discuss Eptinezumab (Vyepti) with your neurologist or headache specialist to see if it's the right choice for your treatment plan.