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. 2021 Oct 25;22(1):128.
doi: 10.1186/s10194-021-01335-2.

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

Fenne Vandervorst  1 , Laura Van Deun  1 , Annelies Van Dycke  2 , Koen Paemeleire  3 , Uwe Reuter  4 , Jean Schoenen  5 , Jan Versijpt  6
Affiliations

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

Fenne Vandervorst et al. J Headache Pain. .

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.

Keywords: Calcitonin gene-related peptide; Chronic migraine; Episodic migraine; Migraine; Monoclonal antibody; Preventive treatment.

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Conflict of interest statement

KP has received personal compensation from Allergan, Amgen/Novartis, Eli Lilly, Lundbeck and Teva for consulting, serving on a scientific advisory board, and/or speaking and is a clinical trial investigator for Amgen/Novartis (erenumab), Eli Lilly (galcanezumab), and Autonomic Technologies Inc. (sphenopalatine ganglion stimulation). UR received consulting fees, speaking/teaching fees, and/or research grants from Allergan, Amgen, Autonomic Technologies, CoLucid, ElectroCore, Eli Lilly, Medscape, Novartis, StreamMedUp and Teva Pharmaceuticals. JS has received personal compensation from Allergan, Amgen/Novartis, Eli Lilly, Lundbeck,Teva, Cefaly Technology, Autonomic Technologies Inc. and Man & Science for consulting, serving on a scientific advisory board, and/or speaking and is an investigator for Eli Lilly, Novartis, Lundbeck and Teva. JV received personal fees and nonfinancial support from Teva, personal fees from Novartis and Lundbeck, and grants and nonfinancial support from Allergan.

Figures

Fig. 1
Fig. 1
dropouts due to AEs and change in MMD versus placebo in episodic migraine patients. The size of the circle corresponds to the number of patients that were treated with the prophylactic agent across all RCTs. can: candesartan; ami: amitriptyline; top: topiramate: val: valproate; CGRP: CGRP mAb; β: beta-blockers; RCT: randomised controlled trial; MMD: monthly migraine days
Fig. 2
Fig. 2
dropouts due to AEs and change in MMD versus placebo in chronic migraine patients. The size of the circle corresponds to the number of patients that were treated with the prophylactic agent across all RCTs. top: topiramate; onabot: onabotulinumtoxinA; CGRP: CGRP MAb; RCT: randomised controlled trial; MMD: monthly migraine days
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