Designed to offer an alternative to triptans, GEPANTS are a new class of medications that have raised much hope in the treatment of migraine. They target specific mechanisms to block pain. Yet despite their promise, their actual effectiveness has been questioned. Here, we explore why GEPANTS may not be the long-awaited solution for migraine treatment.
GEPANTS: What are they and how do they work?
GEPANTS are receptor antagonists for calcitonin gene-related peptide (CGRP ), a protein that plays an important role in triggering migraines . During a migraine attack, CGRP levels increase, causing inflammation and dilation of blood vessels in the brain, which amplifies pain. GEPANTS work by blocking CGRP receptors, preventing this protein from triggering the cascade of events that causes pain.
Unlike triptans, which cause vasoconstriction (narrowing of blood vessels), GEPANTS do not have a direct impact on blood vessels. This makes them an attractive option for people with cardiovascular risks, for whom triptans are contraindicated.
The different GEPANTS available
Currently, several GEPANTS have been approved or are in clinical development. The most popular examples of this class of drugs include:
- Rimegepant (trade name Nurtec ODT ): used both for the acute treatment of migraines and for prevention.
- Ubrogepant (marketed as Ubrelvy ): indicated for the treatment of migraine attacks.
- Atogepant ( Qulipta ): mainly used for the prevention of migraines in adults.
These drugs, available in tablet form, are taken during migraine attacks or as a preventative measure to reduce the frequency of attacks.
Relative efficacy of GEPANTS compared to paracetamol
According to a recent study published in the British Medical Journal (BMJ) , these drugs are not necessarily more effective than triptans or well-known treatments such as paracetamol, ibuprofen, aspirin, diclofenac. It has been shown that for some people, the relief provided by GEPANTS is not superior to that obtained with conventional analgesics. This finding raises the question: why choose a more expensive treatment if you can get similar results with less expensive options ?
Clinical trials show mixed results. While some patients report significant improvement after taking GEPANTS, others do not feel a noticeable difference compared to conventional treatments. This variability calls into question the idea that GEPANTS would be a universal solution for migraine sufferers.
Limited effectiveness depending on the type of migraine
Migraine is a complex phenomenon, and its treatment must be tailored to each patient. While GEPANTS may be effective for some people with mild to moderate migraine, they do not always work for severe migraine. The mechanisms that cause migraine vary from person to person, and GEPANTS, which primarily target the CGRP receptor, only cover part of the pathophysiology of migraine.
Chronic migraines: another problem
GEPANTS show variable efficacy, particularly in people with chronic migraine. These patients, who have frequent and intense attacks, often require more potent and combined treatments. GEPANTS, as monotherapy, may not be sufficient to control symptoms in these patients, who should then explore other treatment options.
Side effects to watch out for
Although GEPANTS are generally better tolerated than triptans, they are not free of side effects. The most common adverse effects include digestive disorders, such as nausea or abdominal pain, as well as skin reactions, although rarer. These effects, although moderate, can affect patients' quality of life and impair their adherence to treatment.
Furthermore, the long-term use of GEPANTS is not yet well documented, as it is a relatively new class of drugs. It is therefore important to closely monitor patients treated with these drugs for the development of long-term adverse effects.
A cost that may dissuade some patients
The cost of GEPANTS is significantly higher than that of traditional treatments such as paracetamol or non-steroidal anti-inflammatory drugs . For a migraine patient suffering from frequent attacks, taking GEPANTS regularly can represent a considerable financial burden.
In a context where access to care is increasingly focused on cost reduction, it is legitimate to question the relevance of such an expensive treatment. If a patient can obtain similar results with a much cheaper drug, the choice of GEPANTS may seem exaggerated, especially since health systems do not always reimburse these new treatments.
Towards personalized medicine for the treatment of migraine
These limitations do not mean that GEPANTS should be excluded from the treatment of migraine. They may represent a valid solution for some patients, particularly those for whom traditional treatments do not work or who cannot tolerate triptans due to cardiovascular risks. However, their use must be targeted and appropriate.
It is important to adopt a personalized approach for each patient. Neurologists and physicians must carefully evaluate the medical history, the nature and frequency of migraines, and the response to previous treatments. Only by having a complete overview can the healthcare professional determine whether GEPANTS are a valid option for optimal treatment.
GEPANTS, a promising advance but to be evaluated with caution
GEPANTS represent a breakthrough in migraine treatments, but their effectiveness must be put into perspective. For many patients, more traditional and accessible treatments, such as paracetamol or anti-inflammatories, are just as effective, if not more so. Side effects, cost, and individual response to treatment are important factors to consider before opting for GEPANTS.
Before turning to this new therapeutic option, it is essential to consult a healthcare professional to evaluate all the available options and determine which treatment is best suited to your situation.
