CGRP monoclonal antibodies and CGRP receptor antagonists (Gepants) in migraine prevention.

Q2 Medicine

Handbook of clinical neurology Pub Date : 2024-01-01 DOI:10.1016/B978-0-12-823357-3.00024-0

Edoardo Caronna, Alicia Alpuente, Marta Torres-Ferrus, Patricia Pozo-Rosich

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Abstract

Migraine is a prevalent and disabling neurological disease. Its preventive treatment for decades has been rather limited due to the absence of disease-specific therapies with limited efficacy and tolerability. The advances made in migraine research have led to the discovery of the calcitonin gene-related peptide (CGRP) and its role in migraine pathophysiology. CGRP is a neuropeptide that acts as potent vasodilator and is involved in pain processing. Increased levels of plasma CGRP have been observed during migraine attacks as well as interictally when comparing patients with migraine and healthy controls. In the last years, two classes of drugs antagonizing CGRP have therefore been developed as the first migraine-specific preventive treatments: anti-CGRP monoclonal antibodies (mAbs) and gepants. Four mAbs have been approved: erenumab, galcanezumab, fremanezumab, and eptinezumab. Gepants are small molecules that antagonize the CGRP receptor; currently only rimegepant and atogepant have been approved for migraine prevention. These new drugs have demonstrated efficacy and safety in clinical trials for both episodic and chronic migraine, and results from their real-world experience are being increasingly reported in literature. In this review, we provide an overview of anti-CGRP drugs and their placement in migraine prevention.

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预防偏头痛的 CGRP 单克隆抗体和 CGRP 受体拮抗剂（Gepants）。

偏头痛是一种常见的致残性神经系统疾病。几十年来，由于缺乏疗效和耐受性有限的疾病特异性疗法，其预防性治疗一直相当有限。随着偏头痛研究的进展，人们发现了降钙素基因相关肽（CGRP）及其在偏头痛病理生理学中的作用。降钙素基因相关肽是一种神经肽，具有强效血管扩张作用，并参与疼痛处理。在偏头痛发作期间以及发作间期，将偏头痛患者与健康对照组进行比较，可观察到血浆 CGRP 水平升高。因此，在过去几年中，人们开发了两类拮抗 CGRP 的药物，作为首批偏头痛特异性预防治疗药物：抗 CGRP 单克隆抗体（mAbs）和 gepants。目前已有四种单克隆抗体获得批准：erenumab、galcanezumab、fremanezumab和eptinezumab。Gepants 是拮抗 CGRP 受体的小分子药物；目前只有 rimegepant 和 atogepant 获准用于偏头痛的预防。这些新药在发作性偏头痛和慢性偏头痛的临床试验中均证明了其疗效和安全性，文献中也越来越多地报道了这些药物的实际疗效。在本综述中，我们将概述抗CGRP药物及其在偏头痛预防中的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Handbook of clinical neurology Medicine-Neurology (clinical)

CiteScore

4.10

自引率

0.00%

发文量

302

期刊介绍： The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.