From the Guidelines
Emgality (galcanezumab) is a strongly recommended preventive medication for episodic or chronic migraine, while Nurtec ODT (rimegepant) is suggested for the short-term treatment of migraine. Emgality is a monthly self-injected preventive medication that blocks CGRP, a pain-causing protein, reducing migraine frequency by 4-5 days per month in clinical trials, as supported by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1. It's administered as a 240mg loading dose followed by 120mg monthly injections. On the other hand, Nurtec ODT is a fast-dissolving tablet primarily used for acute treatment (75mg as needed, up to once daily) but also approved for prevention (75mg every other day). For acute treatment, Nurtec typically relieves pain within 1-2 hours and can prevent migraine recurrence for up to 48 hours. As a preventive, it reduces monthly migraine days by about 4.3 days.
Some key points to consider when prescribing these medications include:
- Common side effects for Emgality include injection site reactions and constipation, while Nurtec may cause nausea and indigestion 1.
- Both medications are generally well-tolerated with fewer side effects than older migraine treatments, making them valuable options for people who haven't responded to or can't tolerate traditional migraine medications.
- The guideline suggests erenumab, fremanezumab, or galcanezumab (Emgality) for the prevention of episodic or chronic migraine, with strong evidence 1.
- For acute treatment, the guideline recommends eletriptan, frovatriptan, rizatriptan, sumatriptan, or zolmitriptan, and suggests rimegepant (Nurtec) or ubrogepant for the short-term treatment of migraine, with weak evidence 1.
Overall, Emgality is a preferred option for preventive treatment, while Nurtec ODT is a viable option for acute treatment or prevention, based on the strongest and most recent evidence from the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1.
From the FDA Drug Label
The efficacy of EMGALITY was evaluated as a preventive treatment of episodic or chronic migraine in three multicenter, randomized, double-blind, placebo-controlled studies: two 6-month studies in patients with episodic migraine (Studies 1 and 2) and one 3-month study in patients with chronic migraine (Study 3) EMGALITY 120 mg demonstrated statistically significant improvements for efficacy endpoints compared to placebo over the 6-month period, as summarized in Table 2. NURTEC ODT 75 mg demonstrated an effect on pain freedom and most bothersome symptom (MBS) freedom at two hours after dosing, compared to placebo The primary efficacy analyses were conducted in patients who treated a migraine with moderate to severe pain. Rimegepant 75 mg dosed every other day demonstrated statistically significant improvements for these efficacy endpoints compared to placebo, as summarized in Table 3
Migraine Treatments: Emgality and Nurtec
- Emgality (galcanezumab):
- Effective as a preventive treatment for episodic migraine, with statistically significant improvements in efficacy endpoints compared to placebo over a 6-month period 2
- Demonstrated a reduction in monthly migraine headache days, with a mean change from baseline of -4.7 days in Study 1 and -4.3 days in Study 2
- Nurtec (rimegepant):
- Effective for the acute treatment of migraine, with statistically significant improvements in pain freedom and most bothersome symptom freedom at 2 hours after dosing, compared to placebo 3
- Also effective for the preventive treatment of episodic migraine, with statistically significant improvements in monthly migraine days and percentage of patients achieving at least a 50% reduction from baseline in moderate to severe migraine days 3
From the Research
Emgality (Galcanezumab) as a Migraine Treatment
- Emgality is a monoclonal antibody targeting calcitonin gene-related peptide (CGRP) given in a monthly injection for the prevention of migraines 4.
- Studies have shown that Emgality is effective in decreasing the frequency and length of migraines, with up to 50% reduction in monthly migraine days and improved functional capacity in migraineurs 4.
- Emgality is well tolerated and safe, with a better tolerability profile compared to existing therapies 4, 5.
Nurtec (Rimegepant) as a Migraine Treatment
- Nurtec is an oral small-molecule CGRP receptor antagonist approved for acute treatment of migraine and preventive treatment of episodic migraine in adults 6, 7.
- Clinical trials have established Nurtec as a safe and effective treatment for migraine, with a favorable safety profile making it suitable for patients with contraindications or intolerance to other treatments 6, 7.
- However, the therapeutic gain of Nurtec is only small, and further research is needed to determine the consequences of long-term CGRP blockade, especially during ischemia or cardiovascular disease 7.
Comparison of Emgality and Nurtec
- Both Emgality and Nurtec target the CGRP pathway, but Emgality is a monoclonal antibody while Nurtec is a small-molecule receptor antagonist 4, 6.
- Emgality has been shown to be effective in reducing monthly migraine days, while Nurtec has been established as a safe and effective treatment for acute and preventive treatment of migraine 4, 6.
- The choice between Emgality and Nurtec may depend on individual patient needs and preferences, as well as cost-effectiveness considerations 8.