A new class of migraine drugs available on the NHS has been linked to a possible rise in miscarriage risk, according to concerning new research.
The treatments, called calcitonin gene-related peptide (CGRP) monoclonal antibodies, are given by injection and have been shown to help prevent migraines in around half of patients.
But findings presented at the American Headache Society (AHS) Annual Meeting in Florida suggest that use of the drugs in early pregnancy may raise the risk of miscarriage by 45 per cent.
The research examined 7,579 pregnancies among 7,119 women aged 15 to 45 who had been diagnosed with migraine before becoming pregnant.
Scientists assessed outcomes across three groups: women using CGRP monoclonal antibody injections, those taking the beta-blocker propranolol, and patients who were not using migraine medication.
They reported that miscarriage rates between eight and 12 weeks of pregnancy rose more sharply among women using CGRP monoclonal antibodies than in the comparison groups.
In total, miscarriages occurred in two per cent of women taking propranolol alone, compared with five per cent of those using CGRP monoclonal antibody treatment.
NHS advice currently says the medication should not be used by women who are pregnant or planning to try for a baby.
The class of medication – known as calcitonin gene-related peptide (CGRP) monoclonal antibodies – are injections that have been shown to prevent the condition in 50 per cent of patients
However, experts say that the research still raises questions about its use.
‘These results support cautious use of anti-CGRP therapies and emphasize the importance of preconception counseling for women of childbearing potential.
‘They also highlight the need for future safety research of pregnancy, including studies of fetal and long-term offspring outcomes,’ said study investigator Dr Leah Flatman from the Centre Hospitalier Universitaire Sainte-Justine in Montreal, Quebec, Canada.
Experts say that the problem is how long the drug stays in the system.
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‘When you give CGRP therapies by injection, they stay in the body for 5 months, so this is an issue that could come up with a lot of different patients that are on CGRP therapies where they have an unexpected pregnancy, or maybe they don’t even know that they should be off of therapy for five months before trying to get pregnant,’ says Professor Vincent Martin, director of the Headache and Facial Pain Center at the University of Cincinnati Gardner Neuroscience.
About seven million people in the UK suffer with migraines, with women three times as likely to get them as men, possibly as attacks are linked to the female hormone oestrogen.
The main symptom is an intense, one-sided headache but nausea and increased sensitivity to light and sound are also experienced.
Most patients rely on painkillers to dull the agony, or prescription drugs called triptans which can shorten the length of attacks.
For years, there was nothing that could prevent migraines or reduce their frequency. Then, in March 2020, the NHS gave the green light to calcitonin gene-related peptide (CGRP) monoclonal antibodies to the most severely affected.
The drugs work by blocking a chemical called calcitonin gene related peptide (CGRP), responsible for the pain and nausea associated with migraines – halving the number of attacks.
There are four anti-CGRP drugs approved for use in the UK – erenumab, galcanezumab, fremanezumab and eptinezumab.
When initially approved, experts branded them ‘wonder drugs’ and ‘life changing’ for patients.
Under NHS guidance patients who suffer a migraine on at least four days in a month or more can also get the jab, potentially helping many more every year.
Patients also need to have tried three or more other preventive medicines at the maximum doses they can tolerate for several months each, and they haven’t worked.
