Dr Stephen Silberstein on the Next Steps for Anti-CGRP Therapies

When it comes to the next steps for anti-CGRP therapies, we need to discuss the concept of synergism, said Stephen Silberstein, MD, professor of neurology at Thomas Jefferson University and director of the Headache Center at Jefferson Health.

Transcript:

The American Journal of Managed Care®(AJMC®):What are the next steps for anti-CGRP therapies?

Dr. Silberstein: What we need to do is talk about the concept of synergism. What do I mean by that? If you take drug A, or you're on an antibody, what drug would work to help it give a better result. What we need to do now is take patients who are on antibodies and find out what drugs may give additional benefit. We did that Once. We did a study with patients on topiramate, stable dose, added either propranolol or the propranolol placebo and showed propranolol added nothing. But I can tell you that in a number of the studies patients were on concomitant medication and adding antibodies to their baseline medication resulted in further improvement showing synergism and not antagonism.

AJMC®:Do you have any final thoughts you would like to share?

Dr. Silberstein:I think the biggest question now is whether if you add a botulinum toxin to an antibody is it synergistic. I think we're getting increasing evidence now that the toxins and the antibodies are synergistic. I think Rami Burstein has shown that the botulinum toxin works on the C fibers, antibodies work on the A delta fibers. In our personal experience, we're actually analyzing data now. It's been our bias that patients are attracted to 1 of the 2, you add them together, you get a better result.