Emgality® ▼ (galcanezumab)

This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information. Please refer to the link for full prescribing information: Emgality Summary of Product Characteristics (SmPC)

Emgality® ▼ (galcanezumab): Use in Patients With Comorbid Psychiatric Disorders

Patients with significant active or unstable psychiatric disease were excluded from participation in the galcanezumab clinical trials.

Detailed Information

Phase 3 Clinical Trial Information

Galcanezumab has been studied in phase 3 randomized, double-blind, placebo-controlled studies in adult patients for the prevention of

  • episodic migraine (EVOLVE-1 and EVOLVE-2),1,2 and

  • chronic migraine (REGAIN).3

Galcanezumab has also been studied in a phase 3, open-label, 12-month safety study for the prevention of episodic or chronic migraine.4

Patients in the phase 3 migraine program were reflective of the migraine patient population with regard to demographics, disease characteristics, and comorbid medical conditions, including depression, anxiety, insomnia, and pain.5,6

Inclusion in Phase 3 Clinical Trials

Patients with major depressive disorder or generalized anxiety disorder whose disease state was  considered stable and expected to remain stable throughout the course of the study, in the opinion of the investigator, were considered for inclusion if they were not on excluded medications.6

Because depression and anxiety are relatively common in people with migraine, this provision ensured that with respect to presence of concomitant depression/anxiety, the patient population would be similar to that seen in clinical practice.6

In the galcanezumab phase 3, randomized, double-blind, placebo-controlled studies for the prevention of migraine (EVOLVE-1, EVOLVE-2, REGAIN), 11.4% of patients had pre-existing anxiety, and 11.9% had pre-existing depression.6 Subgroup analysis of this population was not done.  

Exclusion in Phase 3 Clinical Trials

Clinical trial exclusion criteria included evidence of significant active or unstable psychiatric disease by medical history, such as

  • bipolar disorder

  • schizophrenia

  • personality disorders, or

  • other serious mood or anxiety disorders.6

Patients were excluded if

  • in the clinician’s judgment, they were actively suicidal and therefore deemed to be at significant risk for suicide, or

  • answered “yes” to any of the items in Table 1, and

  • the ideation or behavior occurred within the past month.6

Table 1. Select Columbia Suicide Severity Rating Scale Items6

Domain Evaluated

Description

Suicidal Ideation

Question 4 - Active suicidal ideation with some intent to act, without specific plan

Question 5 - Active suicidal ideation with specific plan and intent

Suicidal Behavior

actual attempt

interrupted attempt

aborted attempt

preparatory act or behavior

Therapeutic Indication

Galcanezumab is indicated for the prophylaxis of migraine in adults who have at least 4 migraine days per month.7

The recommended dose is 120 mg galcanezumab injected subcutaneously once monthly, with a 240 mg loading dose as the initial dose.7

References

1. Stauffer VL, Dodick DW, Zhang Q, et al. Evaluation of galcanezumab for the prevention of episodic migraine: the EVOLVE-1 randomized clinical trial. JAMA Neurol. 2018;75(9):1080-1088. http://dx.doi.org/10.1001/jamaneurol.2018.1212

2. Skljarevski V, Matharu M, Millen BA, et al. Efficacy and safety of galcanezumab for the prevention of episodic migraine: results of the EVOLVE-2 phase 3 randomized controlled clinical trial. Cephalalgia. 2018;38(8):1442-1454. http://dx.doi.org/10.1177/0333102418779543

3. Detke HC, Goadsby PJ, Wang S, et al. Galcanezumab in chronic migraine: the randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018;91(24):e2211-e2221. http://dx.doi.org/10.1212/WNL.0000000000006640

4. Camporeale A, Kudrow D, Sides R, et al. A phase 3, long-term, open-label safety study of galcanezumab in patients with migraine. BMC Neurology. 2018;18(1):188. http://dx.doi.org/10.1186/s12883-018-1193-2

5. Buse DC, Rupnow MFT, Lipton RB. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc. 2009;84(5):422-435. http://dx.doi.org/10.1016/S0025-6196(11)60561-2

6. Data on file, Eli Lilly and Company and/or one of its subsidiaries.

7. Emgality [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions.

Date of Last Review: April 24, 2018

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