CGRP monoclonal antibodies in migraine: an efficacy and tolerability comparison with standard prophylactic drugs

Abstract

Background Several drugs are available for the preventive treatment of both episodic and chronic migraine. The choice of which therapy to initiate first, second, or third is not straightforward and is based on multiple factors, including general efficacy, tolerability, potential for serious adverse events, comorbid conditions, and costs. Recently, a new class of migraine preventive drugs was introduced, i.e. monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptor. Methods The present article summarizes the evidence gathered with this new migraine preventive drug class from randomized placebo-controlled clinical trials. It further puts this into perspective next to the evidence gained by the most widely used agents for the prevention of episodic and chronic migraine with an emphasis on efficacy and the robustness with which this efficacy signal was obtained. Results Although being a relatively new class of migraine preventive drugs, monoclonal antibodies blocking the CGRP pathway have an efficacy which is at least comparable if not higher than those of the currently used preventive drugs. Moreover, the robustness of this efficacy signal is substantiated by several randomized clinical trials each including large numbers of patients. In addition, because of their excellent tolerability and with long-term safety data emerging, they seem to have an unprecedented efficacy over adverse effect profile, clearly resulting in an added value for migraine prevention. Conclusions Balancing the data presented in the current manuscript with additional data concerning long term safety on the one hand and cost issues on the other hand, can be of particular use to health policy makers to implement this new drug class in the prevention of migraine.

Treatment of resistant chronic migraine with anti-CGRP monoclonal antibodies: a systematic review

“…These outcomes (adverse events) presented very low frequencies which were similar to those obtained in patients receiving placebo (Table 6 ). Additionally, these rates were significantly lower and less serious than those reported to occur with traditional migraine prophylactic treatments [ 82 – 85 ].…”

Magnesium as an Important Factor in the Pathogenesis and Treatment of Migraine—From Theory to Practice

“…Also, magnesium may keep the balance of neurotransmitter release, platelet activity, and vasoconstriction [ 46 ]. CGRP level also appears to be related to magnesium [ 47 , 48 , 49 , 50 ].…”

The Safety and Efficacy of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies for the Preventive Treatment of Migraine: A Protocol for Multiple-Treatment Systematic Review and Meta-Analysis

“…However, the treatment of migraines is on the cusp of a new era with the development of drugs targeting the trigeminal sensory neuropeptide calcitonin gene-related peptide (CGRP) or its receptor, which has been shown to play a role in the onset of migraine, and the trigeminovascular pain pathway, with CGRP release, whose peptide levels are the highest, is activated during a migraine attack [14,15]. Monoclonal antibodies against CGRP (eptinezumab, fremanezumab and galcanezumab) or the CGRP receptor (erenumab) effectively prevent migraine attacks [16], which is at least comparable if not superior, to previous preventive drugs, with an unprecedented efficacy profile on adverse effects [17]. Real world Spanish data show that these drugs are equally effective in patients with medication overuse as in those without, and facilitate medication cessation [18].…”

“…Constipation is a significant side effect of the use of monoclonal antibodies against CGRP in relation to Glucagon-Like Peptide-1 regulation [20]. Monoclonal antibodies against CGRP are, indeed, of added value for migraine prevention [17].…”