Eptinezumab on the Pharmaceutical Benefits Scheme

Eptinezumab has been added to the Pharmaceutical Benefits Scheme (PBS) for the preventive treatment of chronic migraine in adults. To qualify for PBS subsidy, patients must average 15 or more headache days per month (with at least eight days of migraine) for at least six months before initiating treatment.

Eptinezumab is a calcitonin gene-related peptide (CGRP) antagonist. Elevated CGRP levels have been associated with migraine, with this neuropeptide implicated in pain modulation. The safety and efficacy of eptinezumab were evaluated in the PROMISE-2 trial. Adults with chronic migraine were randomly assigned to receive eptinezumab 100mg, eptinezumab 300mg, or placebo on day 0 and week 12. Patients in the eptinezumab group achieved a significant reduction in monthly migraine days compared to placebo, with benefits becoming apparent on the first day after initiation of therapy. These results were supported by the longer-term open-label PREVAIL trial. Favourable safety and efficacy profiles were maintained over the two-year trial period. However, this trial used a 300mg dose, which is not subsidised on the PBS.

Other CGRP antagonists available include galcanezumab, fremanezumab, and erenumab. Due to their large molecular size, all of these medicines must be administered parenterally. Galcanezumab and fremanezumab are also available on the PBS.