Objective: To review the new drug class of calcitonin gene-related peptide antagonists (monoclonal antibodies) and their clinical relevance in migraine prophylaxis. Data Sources: A literature search was performed in PubMed (January 2009 to November 2019) using the terms migraine, calcitonin gene-related peptide (CGRP), erenumab, fremanezumab, and galcanezumab for clinical trials and studies. Study Selection and Data Extraction: Reports from human studies in English were evaluated for clinical evidence supporting pharmacology, efficacy, and adverse events. Initial pharmacokinetic and preclinical studies were excluded. Data Synthesis: In chronic and episodic migraine, prophylaxis with injections of monoclonal antibodies antagonizing CGRP reduced monthly migraine days with minimal clinically significant adverse events. In addition, there is evidence supporting efficacy in refractory migraine despite optimal prophylaxis. Relevance to Patient Care and Clinical Practice: This is the first target-specific migraine prophylaxis treatment to show efficacy with minimal adverse effects. A higher drug cost is a barrier but is balanced by improved quality of life. Current therapies have limited efficacy and tolerability because of poor side effect profiles. CGRP antagonists represent a shift to more precise migraine treatments. Conclusions: Monoclonal antibodies inhibiting CGRP are effective in migraine prophylaxis with minimal adverse effects. Targeting CGRP is a novel clinical strategy in managing migraine.
Keywords: CGRP; calcitonin gene-related peptide; headache; migraine.
History and Review of anti-Calcitonin Gene-Related Peptide (CGRP) Therapies: From Translational Research to TreatmentSJ Tepper. Headache 58 Suppl 3, 238-275. PMID 30242830. - ReviewObjective - To briefly describe the history of and available data on anti-calcitonin gene-related peptide (CGRP) therapies for headache. Background - CGRP was proposed as …
New Trends in Migraine Pharmacology: Targeting Calcitonin Gene-Related Peptide (CGRP) With Monoclonal AntibodiesD Scuteri et al. Front Pharmacol 10, 363. PMID 31024319. - ReviewMigraine is a common neurologic disorder characterized by attacks consisting of unilateral, throbbing headache accompanied by photophobia, phonophobia, and nausea which r …
Anti-Calcitonin Gene-Related Peptide (CGRP) Therapies: Update on a Previous Review After the American Headache Society 60th Scientific Meeting, San Francisco, June 2018SJ Tepper. Headache 58 Suppl 3, 276-290. PMID 30403405. - ReviewThe development of anti-CGRP therapies opens a new era in the acute and preventive treatment of primary headache disorders.
The Efficacy and Safety of Calcitonin Gene-Related Peptide Monoclonal Antibody for Episodic Migraine: A Meta-AnalysisY Zhu et al. Neurol Sci 39 (12), 2097-2106. PMID 30182284. - Meta-AnalysisBased on the results of this meta-analysis, CGRP monoclonal antibodies significantly reduced the monthly migraine days and acute migraine-specific medication. CGRP monocl …
The Biology of Monoclonal Antibodies: Focus on Calcitonin Gene-Related Peptide for Prophylactic Migraine TherapyB Raffaelli et al. Neurotherapeutics 15 (2), 324-335. PMID 29616494. - ReviewCalcitonin gene-related peptide (CGRP) is 37-amino-acid neuropeptide, crucially involved in migraine pathophysiology. Four monoclonal antibodies (mAbs) targeting the CGRP …