Gepants are new oral migraine medications specifically developed for migraine. Gepants are a type of calcitonin gene-related peptide (CGRP) inhibitor, targeting the same peptide as the injectable CGRP medications currently available in New Zealand, Aimovig and Emgality.
Four gepants are approved overseas for use:
- Atogepant (Qulipta)
- Ubrogepant (Ubrelvy)
- Rimegepant (Nurtec ODT)
- Zavegepant (Zavzpret)
Gepants come as an oral tablet (zavegepant also comes as a nasal spray) and were originally developed to treat a migraine attack, much like triptans. However, atogepant (Qulipta) was developed for use as a migraine preventive medication, taken daily, and Rimegepant (Nurtec) has also been approved for migraine prevention when taken every other day.
No gepants are available in New Zealand yet. However, AbbVie, the pharmaceutical company that makes atogepant (Qulipta), has submitted an application to MedSafe for safety approval in New Zealand. Medsafe is discussing the application on 25 May 2023 at its Medicines Classification Committee meeting, which is the first step in the process for getting approval to sell atogepant in New Zealand. After Medsafe has approved atogepant, an application to Pharmac can be made to request funding for the medication.
Why gepants are a promising addition to migraine management
Gepants used for prevention, like other CGRP-targeted medications, are well tolerated and have fewer side effects than other medications used to prevent migraine. Gepants used for acute attacks can be a good option for people who can’t take or tolerate triptans, or for whom triptans don’t work.
Early indications suggest that gepants aren’t associated with medication overuse headaches. Many people with migraine struggle with medication overuse headaches, which can occur when a person takes too many acute medications to treat migraine over a period of at least three months. Medication overuse headaches are not the fault of a person with migraine, but a sign that there is a huge need for migraine medication options specifically designed for migraine with an improved safety profile. Gepants may be the answer.