Galcanezumab

Products

Galcanezumab was approved in the United States and EU in 2018 and in many countries in 2019 as a solution for injection in a prefilled pen and a prefilled syringe (Emgality, Eli Lilly).

Structure and properties

Galcanezumab is a humanized IgG4 monoclonal antibody with a molecular mass of 147 kDa against CGRP. It is produced by biotechnological methods.

Effects

Galcanezumab (ATC N02CX08) reduces the number of migraine attacks. The effects are due to binding of the antibody to CGRP, calcitonin gene-related peptide. CGRP is a neuropeptide that plays an important role in triggering migraine attacks. It consists of 37 amino acids and is expressed in the peripheral and central nervous systems. Two isoforms exist, CGRP-α (Figure) and CGRP-β, which differ in three amino acids. Both are agonists at the CGRP receptor. CGRP has potent vasodilatory properties and plays a central role in pain initiation as well as neurogenic inflammation. Migraineurs have been found to have elevated levels of CGRP during an attack, and intravenous administration of the peptide can induce attacks in migraineurs. The triptans administered for the treatment of migraine attacks also inhibit the release of CGRP. The half-life of galcanezumab is in the range of 27 days.

Indications

For migraine prophylaxis in adults with at least 4 migraine days per month.

Dosage

According to the SmPC. The drug needs to be injected subcutaneously only once a month because of its long half-life. It can be self-administered by patients after instruction by healthcare professionals.

Contraindications

  • Hypersensitivity

For complete precautions, see the drug label.

Interactions

Drug-drug interactions have not been reported to date.

Adverse effects

The most common possible adverse effects include injection site reactions and pain.