How to integrate monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor in daily clinical practice

Abstract

Background: Migraine is a major public health issue associated with significant morbidity, considerable negative impact on quality of life, and significant socioeconomic burden. Preventive treatments are required to reduce the occurrence and the severity of acute attacks and to minimize the use of abortive medications and the associate risk of drug-related adverse events, as well as the onset of medication-overuse headache and chronification of migraine. We performed a review of all available evidence on the safety and efficacy of monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor for the preventive treatment of migraine to provide evidence-based guidance on their use in clinical practice. Monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor are mechanism-specific drugs for the preventive treatment of migraine. Double-blind randomized clinical trials have shown that monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor are effective across all the spectrum of migraine patients who require prevention and have a good safety and tolerability profile. Nevertheless, high costs limit the affordability of those drugs at the moment.

Conclusions: Specificity, long half-life, efficacy, tolerability, and ease of use make monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor an appealing treatment option for migraine prevention. Optimal strategies to manage treatment over time still need to be clarified with real-life data.

Keywords: Calcitonin gene-related peptide; Migraine; Monoclonal antibodies; Preventive treatment.

Fig. 1

Data showing the results of treatment with CGRP(r) MoAbs on the main efficacy endpoints in patients with episodic migraine

Fig. 2

Data showing the results of CGRP(r) MoAbs on the main efficacy endpoints in patients with chronic migraine