Calcitonin gene–related peptide in migraine: from pathophysiology to treatment

Santos-Lasaosa, S; Belvís, R.; Cuadrado, M.L.; Díaz-Insa, S.; Gago-Veiga, Ana Beatriz; Ál, Guerrero-Peral; Huerta, Mariano Jiménez; Irimia, P.; Laínez, José Miguel; Latorre, G.; Leira, Rogelio; Pascual, Julio; Porta‐Etessam, J.; Río, Margarita Sánchez del; Viguera, J.; Pozo‐Rosich, Patricia

doi:10.1016/j.nrleng.2019.03.025

Cited by 7 publications

(5 citation statements)

References 65 publications

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“…Also, it is demonstrated that CGRP infusion in migraine patients causes migraine-like attacks ( 29 , 30 ). As a result, the CGRP is a potential biological marker in acute migraines ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

Immunologic aspects of migraine: A review of literature

et al. 2022

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Migraine headaches are highly prevalent, affecting 15% of the population. However, despite many studies to determine this disease's mechanism and efficient management, its pathophysiology has not been fully elucidated. There are suggested hypotheses about the possible mediating role of mast cells, immunoglobulin E, histamine, and cytokines in this disease. A higher incidence of this disease in allergic and asthma patients, reported by several studies, indicates the possible role of brain mast cells located around the brain vessels in this disease. The mast cells are more specifically within the dura and can affect the trigeminal nerve and cervical or sphenopalatine ganglion, triggering the secretion of substances that cause migraine. Neuropeptides such as calcitonin gene-related peptide (CGRP), neurokinin-A, neurotensin (NT), pituitary adenylate-cyclase-activating peptide (PACAP), and substance P (SP) trigger mast cells, and in response, they secrete pro-inflammatory and vasodilatory molecules such as interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) as a selective result of corticotropin-releasing hormone (CRH) secretion. This stress hormone contributes to migraine or intensifies it. Blocking these pathways using immunologic agents such as CGRP antibody, anti-CGRP receptor antibody, and interleukin-1 beta (IL-1β)/interleukin 1 receptor type 1 (IL-1R1) axis-related agents may be promising as potential prophylactic migraine treatments. This review is going to summarize the immunological aspects of migraine.

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Section: Methodsmentioning

confidence: 99%

Immunologic aspects of migraine: A review of literature

et al. 2022

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“…Existen cuatro anticuerpos monoclonales contra el CGRP que han demostrado ser seguros y eficaces contra la migraña [2][3][4][5][6] . De ellos, tres (erenumab, galcanezumab y fremanezumab) han sido aprobados por la European Medicine Agency (EMA) para el tratamiento preventivo de la migraña en pacientes con cuatro o más días de migraña al mes.…”

Section: Introducción Los Anticuerpos Monoclonales Dirigidos Contra E...unclassified

Eficacia y seguridad del fremanezumab según datos de la vida real

Ull¹

2024

KRANION

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“…Over the past decade, the landscape of migraine treatment has undergone a significant transformation with the introduction of monoclonal antibodies (MAb) targeting calcitonin gene-related peptide (CGRP) as a prophylactic approach [4][5][6][7][8]. Currently, four anti-CGRP MAb (galcanezumab, erenumab, fremanezumab and eptinezumab) are available.…”

Section: Introductionmentioning

confidence: 99%

RE‐START: Exploring the effectiveness of anti‐calcitonin gene‐related peptide resumption after discontinuation in migraine

Romero del Rincón,

Gonzalez‐Martinez,

Quintas

et al. 2024

Euro J of Neurology

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Background and purposeAccording to the latest European guidelines, discontinuation of monoclonal antibodies against calcitonin gene‐related peptide (anti‐CGRP MAb) may be considered after 12–18 months of treatment. However, some patients may worsen after discontinuation. In this study, we assessed the response following treatment resumption.MethodsThis was a prospective study conducted in 14 Headache Units in Spain. We included patients with response to anti‐CGRP MAb with clinical worsening after withdrawal and resumption of treatment. Numbers of monthly migraine days (MMD) and monthly headache days (MHD) were obtained at four time points: before starting anti‐CGRP MAb (T‐baseline); last month of first treatment period (T‐suspension); month of restart due to worsening (T‐worsening); and 3 months after resumption (T‐reintroduction). The response rate to resumption was calculated. Possible differences among periods were analysed according to MMD and MHD.ResultsA total of 360 patients, 82% women, with a median (interquartile range [IQR]) age at migraine onset of 18 (12) years. The median (IQR) MHD at T‐baseline was 20 (13) and MMD was 5 (6); at T‐suspension, the median (IQR) MHD was 5 (6) and MMD was 4 (5); at T‐worsening, the median (IQR) MHD was 16 (13) and MMD was 12 (6); and at T‐reintroduction, the median (IQR) MHD was 8 (8) and MHD was 5 (5). In the second period of treatment, a 50% response rate was achieved by 57.4% of patients in MHD and 65.8% in MMD. Multivariate models showed significant differences in MHD between the third month after reintroduction and last month before suspension of first treatment period (p < 0.001).ConclusionThe results suggest that anti‐CGRP MAb therapy is effective after reintroduction. However, 3 months after resumption, one third of the sample reached the same improvement as after the first treatment period.

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Calcitonin gene–related peptide in migraine: from pathophysiology to treatment

Cited by 7 publications

References 65 publications

Immunologic aspects of migraine: A review of literature

Immunologic aspects of migraine: A review of literature

Eficacia y seguridad del fremanezumab según datos de la vida real

RE‐START: Exploring the effectiveness of anti‐calcitonin gene‐related peptide resumption after discontinuation in migraine

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