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Monoclonal antibodies for the prevention of migraine.
Expert Opin Biol Ther. 2019 12; 19(12):1307-1317.EO

Abstract

Introduction: Calcitonin Gene-Related Peptide (CGRP) plays a crucial role in migraine pathophysiology. A novel specific treatment strategy for the prevention of migraine incorporates monoclonal antibodies (mAbs) against CGRP and its canonical receptor. Eptinezumab, fremanezumab and galcanezumab block CGRP mediated effects by binding to the peptide, while erenumab blocks the CGRP receptor.Areas covered: Following a brief overview of pharmacological characteristics, we will review phase III trials for the use of CGRP mAbs in the prevention of episodic and chronic migraine.Expert opinion: All four CGRP mAbs demonstrated an excellent safety, tolerability and efficacy profile in migraine patients. Across all trials mAbs showed superior efficacy for the reduction of monthly migraine days compared to placebo with a net benefit of 2.8 days. Neither cardiovascular nor immunological safety concerns have emerged from clinical trials. Fremanezumab, galcanezumab, and erenumab are approved in the USA and Europe. Based on trial data there is no reason why these mAbs should not become first-line therapies in future. For now, we advocate for the use of mAbs in migraine prevention for patients who failed a minimum of two standard oral treatments based on the novelty and costs of this approach. mAbs are also effective in patients with medication overuse and with comorbid depression or anxiety disorders. Taken together, mAbs are likely to usher in a new era in migraine prevention and provide significant value to patients.

Authors+Show Affiliations

Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany. Clinician Scientist Programm, Berlin Institute of Health (BIH), Berlin, Germany.Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31550937

Citation

Raffaelli, Bianca, et al. "Monoclonal Antibodies for the Prevention of Migraine." Expert Opinion On Biological Therapy, vol. 19, no. 12, 2019, pp. 1307-1317.
Raffaelli B, Neeb L, Reuter U. Monoclonal antibodies for the prevention of migraine. Expert Opin Biol Ther. 2019;19(12):1307-1317.
Raffaelli, B., Neeb, L., & Reuter, U. (2019). Monoclonal antibodies for the prevention of migraine. Expert Opinion On Biological Therapy, 19(12), 1307-1317. https://doi.org/10.1080/14712598.2019.1671350
Raffaelli B, Neeb L, Reuter U. Monoclonal Antibodies for the Prevention of Migraine. Expert Opin Biol Ther. 2019;19(12):1307-1317. PubMed PMID: 31550937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monoclonal antibodies for the prevention of migraine. AU - Raffaelli,Bianca, AU - Neeb,Lars, AU - Reuter,Uwe, Y1 - 2019/10/03/ PY - 2019/9/26/pubmed PY - 2020/4/23/medline PY - 2019/9/26/entrez KW - CGRP KW - chronic migraine KW - clinical trial KW - migraine KW - phase III KW - placebo SP - 1307 EP - 1317 JF - Expert opinion on biological therapy JO - Expert Opin Biol Ther VL - 19 IS - 12 N2 - Introduction: Calcitonin Gene-Related Peptide (CGRP) plays a crucial role in migraine pathophysiology. A novel specific treatment strategy for the prevention of migraine incorporates monoclonal antibodies (mAbs) against CGRP and its canonical receptor. Eptinezumab, fremanezumab and galcanezumab block CGRP mediated effects by binding to the peptide, while erenumab blocks the CGRP receptor.Areas covered: Following a brief overview of pharmacological characteristics, we will review phase III trials for the use of CGRP mAbs in the prevention of episodic and chronic migraine.Expert opinion: All four CGRP mAbs demonstrated an excellent safety, tolerability and efficacy profile in migraine patients. Across all trials mAbs showed superior efficacy for the reduction of monthly migraine days compared to placebo with a net benefit of 2.8 days. Neither cardiovascular nor immunological safety concerns have emerged from clinical trials. Fremanezumab, galcanezumab, and erenumab are approved in the USA and Europe. Based on trial data there is no reason why these mAbs should not become first-line therapies in future. For now, we advocate for the use of mAbs in migraine prevention for patients who failed a minimum of two standard oral treatments based on the novelty and costs of this approach. mAbs are also effective in patients with medication overuse and with comorbid depression or anxiety disorders. Taken together, mAbs are likely to usher in a new era in migraine prevention and provide significant value to patients. SN - 1744-7682 UR - https://www.unboundmedicine.com/medline/citation/31550937/Monoclonal_antibodies_for_the_prevention_of_migraine_ L2 - https://www.tandfonline.com/doi/full/10.1080/14712598.2019.1671350 DB - PRIME DP - Unbound Medicine ER -