Blocking CGRP in migraine patients – a review of pros and cons

The Journal of Headache and Pain

Review Article

Marie Deen¹  Edvige Correnti²  Simone Vigneri³  Lars Edvinsson⁴  Tim Kelderman⁵  Katharina Kamm⁶  Antoinette Maassen Van Den Brink⁷  Eloisa Rubio-Beltrán⁷  Laura Papetti⁸ 

[1] Danish Headache Center, Department of Neurology, Rigshospitalet, Copenhagen, Denmark;Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy;Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo; Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy;Department of Internal Medicine, Institute of Clinical Sciences, Lund University, Lund, Sweden;Department of Neurology, Ghent University Hospital, Ghent, Belgium;Department of Neurology, University Hospital, LMU, Munich, Germany;Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands;Headache Center, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy;

关键词: Migraine;    Cgrp;    Cgrp receptor;    Prophylactic treatment;    Acute treatment;    Gepants;   

DOI  :  10.1186/s10194-017-0807-1

 received in 2017-07-26, accepted in 2017-09-14,  发布年份 2017

来源: Springer

【 摘 要 】

Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceed the cons.

【 授权许可】

CC BY   
© The Author(s). 2017