What is the brand name (e.g. Vyepti (eptinezumab)) of a calcitonin gene-related peptide (CGRP) monoclonal antibody that can be administered every three months for migraine prevention?

Vyepti (Eptinezumab): The CGRP Monoclonal Antibody Administered Every Three Months

Vyepti (eptinezumab) is the brand name of the calcitonin gene-related peptide (CGRP) monoclonal antibody that can be administered every three months for migraine prevention. 1

Mechanism and Administration

Eptinezumab is administered as an intravenous infusion every 3 months (quarterly), making it unique among CGRP monoclonal antibodies in terms of both administration route and dosing frequency. 1, 2

• Dosing options:

  • 100 mg every 3 months
  • 300 mg every 3 months 1

• Pharmacokinetic profile:

  • Exhibits linear pharmacokinetics
  • Reaches steady-state plasma concentration after the first dose
  • Has a terminal elimination half-life of approximately 27 days
  • Administered as an intravenous infusion over approximately 30 minutes 1

Efficacy Profile

Eptinezumab demonstrates significant efficacy for migraine prevention:

• Reduces mean monthly migraine days compared to placebo
• Shows efficacy in both episodic and chronic migraine 1
• Demonstrates rapid onset of action, with benefits observed as early as day 1 after administration 3
• Maintains consistent efficacy throughout the 3-month dosing interval 4

Position in Treatment Algorithm

While eptinezumab is effective, current guidelines position it as a later-line therapy:

• First-line options typically include beta blockers (metoprolol, propranolol), antiseizure medications (valproate), SNRIs (venlafaxine), or TCAs (amitriptyline) 2
• CGRP monoclonal antibodies, including eptinezumab, are generally recommended after failure of first-line treatments 2, 5
• The American Headache Society specifically positions CGRP monoclonal antibodies as third-line treatments 5

Practical Considerations

Several factors influence the selection of eptinezumab:

• Advantages:

  • Quarterly dosing schedule (every 3 months) improves convenience and adherence 2
  • Favorable safety profile with minimal adverse events 4
  • Rapid onset of action compared to many oral preventives 3

• Disadvantages:

  • Requires healthcare facility visit for IV administration 2
  • Higher cost compared to traditional oral preventives (annual cost ranges from $7,071 to $22,790) 2
  • Limited by insurance coverage in many regions 6

Safety Profile

Eptinezumab demonstrates a favorable safety profile:

• Most common adverse events include nasopharyngitis, upper respiratory tract infections, and sinusitis 4
• No significant drug interactions reported 1
• Not metabolized by cytochrome P450 enzymes, reducing potential for medication interactions 1
• Contraindicated in patients with history of cardiovascular disease 5, 6

Clinical Pearls

• Eptinezumab is the only CGRP monoclonal antibody administered intravenously, which may be advantageous for patients who prefer not to self-inject 2
• Treatment response should be assessed after 3-6 months 5
• Consider discontinuing after 6-12 months of successful therapy to evaluate continued need 5
• The need for IV administration requires healthcare infrastructure, which may limit accessibility for some patients 2
• Effectiveness may be reduced in patients who have failed previous CGRP monoclonal antibody treatments 7

Eptinezumab represents an important option in the migraine prevention armamentarium, particularly for patients who prefer less frequent dosing or have failed other preventive treatments.