A Popperian View on Anti‐CGRP Biologics in Migraine

Progress in the Treatment of Migraine Attacks: From Traditional Approaches to Eptinezumab

“…The presence of CGRP immunoreactive fibres around cerebral vessels originating from the trigeminal ganglion has been demonstrated (Figure 2) shedding light on the neurogenic activities exerted by the trigemino-cerebrovascular system [45]. However, the site of action of anti-CGRP mAbs, peripheral or intracerebral, is still a debated issue though there is pharmacological evidence in support of a central action [46]; the latter strengthens the need for deepened investigation to understand the therapeutic potential of the latter biologics. Erenumab efficacy has been studied in the randomized, double-blind, placebo-controlled, phase III "Study to Evaluate the Efficacy and Safety of Erenumab (AMG 334) Compared to Placebo in Migraine Prevention (ARISE)" However, the site of action of anti-CGRP mAbs, peripheral or intracerebral, is still a debated issue though there is pharmacological evidence in support of a central action [46]; the latter strengthens the need for deepened investigation to understand the therapeutic potential of the latter biologics.…”

“…However, the site of action of anti-CGRP mAbs, peripheral or intracerebral, is still a debated issue though there is pharmacological evidence in support of a central action [ 46 ]; the latter strengthens the need for deepened investigation to understand the therapeutic potential of the latter biologics. Erenumab efficacy has been studied in the randomized, double-blind, placebo-controlled, phase III “Study to Evaluate the Efficacy and Safety of Erenumab (AMG 334) Compared to Placebo in Migraine Prevention (ARISE)” (NCT02483585) [ 47 ], showing significant differences with the placebo in monthly migraine days (MMDs) and a ≥50% reduction in 39.7%, with the typical side effects of these treatments most frequently consisting in upper respiratory tract infections and injection site pain.…”

“…However, the site of action of anti-CGRP mAbs, peripheral or intracerebral, is still a debated issue though there is pharmacological evidence in support of a central action [46]; the latter strengthens the need for deepened investigation to understand the therapeutic potential of the latter biologics. Erenumab efficacy has been studied in the randomized, double-blind, placebo-controlled, phase III "Study to Evaluate the Efficacy and Safety of Erenumab (AMG 334) Compared to Placebo in Migraine Prevention (ARISE)" However, the site of action of anti-CGRP mAbs, peripheral or intracerebral, is still a debated issue though there is pharmacological evidence in support of a central action [46]; the latter strengthens the need for deepened investigation to understand the therapeutic potential of the latter biologics. Erenumab efficacy has been studied in the randomized, doubleblind, placebo-controlled, phase III "Study to Evaluate the Efficacy and Safety of Erenumab (AMG 334) Compared to Placebo in Migraine Prevention (ARISE)" (NCT02483585) [47], showing significant differences with the placebo in monthly migraine days (MMDs) and a ≥50% reduction in 39.7%, with the typical side effects of these treatments most frequently consisting in upper respiratory tract infections and injection site pain.…”

Monoclonal antibodies blocking CGRP transmission: An update on their added value in migraine prevention

“…This might imply that they have no effect on migraine-associated symptoms due to factors located upstream in the pathophysiological cascade leading to the migraine attack, like the migraine aura, premonitory symptoms or interictal cognitive abnormalities. It should be kept in mind, however, that at the level of certain brain areas with an absent or less efficient blood-brain barrier, like the circumventricular organs and hypothalamic areas, the CGRP/rec mAbs might penetrate in sufficient amounts to exert a pharmacological effect [19,20].…”

Monoklonale Antikörper gegen CGRP oder den CGRP-Rezeptor in der Migräneprophylaxe

“…Demgegenüber berichtet Chiarugi [19] über eigene Beobachtungen, wonach es zu einer Besserung des kompletten Spektrums an Migränesymptomen gekommen sei und nutzt dies als Teil einer umfassenderen Argumentation, mit der ein zentralnervöser Wirkort der monoklonalen Antikörper belegt werden soll. Als Diskussi-onsgrundlage interessant ist die Anmerkung des Autors, allein die Bezeichnung als migränepräventiv falsifiziere die Annahme eines Wirkortes außerhalb der Blut-Hirn-Schranke.…”