CGRP Antagonists for the Treatment of Chronic Migraines: a Comprehensive Review

Urits, Ivan; Jones, Mark R.; Gress, Kyle; Charipova, Karina; Fiocchi, Jacob; Kaye, Alan D.; Viswanath, Omar

doi:10.1007/s11916-019-0768-y

Cited by 33 publications

(17 citation statements)

References 57 publications

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“…63 They are free of cardiovascular adverse effects. [67][68][69] Although there are theoretical concerns regarding vasoconstriction with this class of drugs, those concerns have not been confirmed clinically. 70…”

Section: Consensusmentioning

confidence: 99%

Preoperative Management of Opioid and Nonopioid Analgesics: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

O'Rourke

Keshock

Boxhorn

et al. 2021

Mayo Clinic Proceedings

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Section: Consensusmentioning

confidence: 99%

Preoperative Management of Opioid and Nonopioid Analgesics: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

O'Rourke

Keshock

Boxhorn

et al. 2021

Mayo Clinic Proceedings

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“…The ultimate goal of preventive treatment is to reduce excessive use of acute treatments [3,4]. Calcitonin gene-related peptide inhibitors are monoclonal antibodies (e.g., erenumab, fremanezumab and galcanezumab) and relatively new preventive therapies for migraine that were not included in the studies mentioned above as they had not been commercially available at the time [5,6]. Migraine attacks are undertreated, particularly in terms of preventive treatment.…”

Section: Introductionmentioning

confidence: 99%

Care Among Migraine Patients in a Commercially Insured Population

et al. 2020

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Introduction: Migraine management is characterized by the poor use of preventive therapy and the overuse of acute medications. An analysis of current treatment patterns in migraineurs is needed to improve care in this patient population. The aim of this study was to describe treatment patterns and healthcare utilization of newly diagnosed migraine patients. Methods: This was a retrospective observation study of newly diagnosed migraine patients (no indication of migraine in the past year) identified in the IBM MarketScan Commercial Claims and Encounters database from 1 January 2010 to 30 June 2014. The final study population comprised persons aged 18-64 years at index (new diagnosis of migraine) with 12 months of continuous enrollment in an insurance plan with medical and pharmacy benefits pre-index and post-index. Treatment patterns and healthcare resource utilization were assessed during the post-index period (at least 12-months). Results: Of the 1,588,666 migraine patients identified in the database as potentially eligible to participate in the study, 284,719 (17.9%) met the final inclusion criteria. Patients generally used acute and preventive therapies to manage migraine attacks, with most patients using preventive therapy (59.1%). However, 67.9% of those using preventive therapy discontinued the current therapy, with a median time to discontinuation of 5 months. Most of the patients who discontinued preventative therapy also used an acute treatment to manage migraine attacks after discontinuation (77.6%), generally in the year following discontinuation (68.4%). Patients on acute therapies were found to use triptans excessively (1.6%) and other non-migraine-specific acute medications for treatment (7.1%). Acute patients were also at risk of opioid dependence (12.0%) and commonly received opioids or barbiturates as firstline therapy (34.1%). Conclusion: Newly diagnosed migraine patients are not being properly treated, as indicated by their excessive use of acute therapies and short time on preventive treatment before discontinuation of that treatment. Further study of the reasons why patients discontinue preventive therapy (adverse events, no response, etc.) and continue to excessively use acute treatments once their treatment regimen has been established is needed.

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“…Recently, botulinum toxin, calcitonin gene-related peptide (CGRP) antagonists and antibodies to CGRP and CGRP receptors have been developed for long term control of migraine headaches (Matak et al, 2011;Dodick et al, 2014a;Dodick et al, 2014b;Lupi et al, 2019). However, these therapies typically reduce the incidence of migraine by just a few attacks per month (Dodick et al, 2019;Urits et al, 2019), indicating that extended therapy for chronic migraine is still not satisfactory. Given the debilitating nature of migraine headaches and the large number of people who suffer from the disease novel therapies are needed.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Characterization of Orofacial Nociception in Female Rats Following Nitroglycerin Administration

Caudle

Flenor

et al. 2020

Front. Pharmacol.

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Rodent models of human disease can be valuable for understanding the mechanisms of a disease and for identifying novel therapies. However, it is critical that these models be vetted prior to committing resources to developing novel therapeutics. Failure to confirm the model can lead to significant losses in time and resources. One model used for migraine headache is to administer nitroglycerin to rodents. Nitroglycerin is known to produce migraine-like pain in humans and is presumed to do the same in rodents. It is not known, however, if the mechanism for nitroglycerin headaches involves the same pathological processes as migraine. In the absence of known mechanisms, it becomes imperative that the model not only translates into successful clinical trials but also successfully reverse translates by demonstrating efficacy of current therapeutics. In this study female rats were given nitroglycerin and nociception was evaluated in OPADs. Estrous was not monitored. Based on the ED50 of nitroglycerin a dose of 10 mg/kg was used for experiments. Sumatriptan, caffeine, buprenorphine and morphine were administered to evaluate the reverse translatability of the model. We found that nitroglycerin did not produce mechanical allodynia in the face of the rats, which is reported to be a consequence of migraine in humans. Nitroglycerin reduced the animals’ participation in the assay. The reduced activity was verified using an assay to measure exploratory behavior. Furthermore, the effects of nitroglycerin were not reversed or prevented by agents that are effective acute therapies for migraine. Two interesting findings from this study, however, were that morphine and nitroglycerin interact to increase the rats’ tolerance of mechanical stimuli on their faces, and they work in concert to slow down the central motor pattern generator for licking on the reward bottle. These interactions suggest that nitroglycerin generated nitric oxide and mu opioid receptors interact with the same neuronal circuits in an additive manner. The interaction of nitroglycerin and morphine on sensory and motor circuits deserves additional examination. In conclusion, based on the results of this study the use of nitroglycerin at these doses in naïve female rats is not recommended as a model for migraine headaches.

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CGRP Antagonists for the Treatment of Chronic Migraines: a Comprehensive Review

Cited by 33 publications

References 57 publications

Preoperative Management of Opioid and Nonopioid Analgesics: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Preoperative Management of Opioid and Nonopioid Analgesics: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Care Among Migraine Patients in a Commercially Insured Population

Pharmacological Characterization of Orofacial Nociception in Female Rats Following Nitroglycerin Administration

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