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Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class.
Ann Pharmacother. 2020 08; 54(8):795-803.AP

Abstract

Objective:

To review the new drug class of calcitonin gene-related peptide antagonists (monoclonal antibodies) and their clinical relevance in migraine prophylaxis. Data Sources: A literature search was performed in PubMed (January 2009 to November 2019) using the terms migraine, calcitonin gene-related peptide (CGRP), erenumab, fremanezumab, and galcanezumab for clinical trials and studies. Study Selection and Data Extraction: Reports from human studies in English were evaluated for clinical evidence supporting pharmacology, efficacy, and adverse events. Initial pharmacokinetic and preclinical studies were excluded. Data Synthesis: In chronic and episodic migraine, prophylaxis with injections of monoclonal antibodies antagonizing CGRP reduced monthly migraine days with minimal clinically significant adverse events. In addition, there is evidence supporting efficacy in refractory migraine despite optimal prophylaxis. Relevance to Patient Care and Clinical Practice: This is the first target-specific migraine prophylaxis treatment to show efficacy with minimal adverse effects. A higher drug cost is a barrier but is balanced by improved quality of life. Current therapies have limited efficacy and tolerability because of poor side effect profiles. CGRP antagonists represent a shift to more precise migraine treatments.

Conclusions:

Monoclonal antibodies inhibiting CGRP are effective in migraine prophylaxis with minimal adverse effects. Targeting CGRP is a novel clinical strategy in managing migraine.

Authors+Show Affiliations

Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.Department of Pharmacy, Mayo Clinic Hospital, Phoenix, AZ, USA.Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.Department of Pharmacy, Mayo Clinic Hospital, Phoenix, AZ, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32019317

Citation

Arca, Karissa, et al. "Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class." The Annals of Pharmacotherapy, vol. 54, no. 8, 2020, pp. 795-803.
Arca K, Reynolds J, Sands KA, et al. Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class. Ann Pharmacother. 2020;54(8):795-803.
Arca, K., Reynolds, J., Sands, K. A., & Shiue, H. J. (2020). Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class. The Annals of Pharmacotherapy, 54(8), 795-803. https://doi.org/10.1177/1060028020903417
Arca K, et al. Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class. Ann Pharmacother. 2020;54(8):795-803. PubMed PMID: 32019317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class. AU - Arca,Karissa, AU - Reynolds,Jenna, AU - Sands,Kara A, AU - Shiue,Harn J, Y1 - 2020/02/05/ PY - 2020/2/6/pubmed PY - 2020/10/31/medline PY - 2020/2/6/entrez KW - CGRP KW - calcitonin gene-related peptide KW - headache KW - migraine SP - 795 EP - 803 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 54 IS - 8 N2 - Objective: To review the new drug class of calcitonin gene-related peptide antagonists (monoclonal antibodies) and their clinical relevance in migraine prophylaxis. Data Sources: A literature search was performed in PubMed (January 2009 to November 2019) using the terms migraine, calcitonin gene-related peptide (CGRP), erenumab, fremanezumab, and galcanezumab for clinical trials and studies. Study Selection and Data Extraction: Reports from human studies in English were evaluated for clinical evidence supporting pharmacology, efficacy, and adverse events. Initial pharmacokinetic and preclinical studies were excluded. Data Synthesis: In chronic and episodic migraine, prophylaxis with injections of monoclonal antibodies antagonizing CGRP reduced monthly migraine days with minimal clinically significant adverse events. In addition, there is evidence supporting efficacy in refractory migraine despite optimal prophylaxis. Relevance to Patient Care and Clinical Practice: This is the first target-specific migraine prophylaxis treatment to show efficacy with minimal adverse effects. A higher drug cost is a barrier but is balanced by improved quality of life. Current therapies have limited efficacy and tolerability because of poor side effect profiles. CGRP antagonists represent a shift to more precise migraine treatments. Conclusions: Monoclonal antibodies inhibiting CGRP are effective in migraine prophylaxis with minimal adverse effects. Targeting CGRP is a novel clinical strategy in managing migraine. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/32019317/Calcitonin_Gene_Related_Peptide_Antagonists_for_the_Prevention_of_Migraine:_Highlights_From_Pivotal_Studies_and_the_Clinical_Relevance_of_This_New_Drug_Class_ L2 - https://journals.sagepub.com/doi/10.1177/1060028020903417?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -