The Arrival of Anti-CGRP Monoclonal Antibodies in Migraine

Remarkable advancements have been made in the field of migraine pathophysiology and pharmacotherapy over the past decade. Understanding the molecular mechanism of calcitonin gene-related peptide (CGRP) has led to the discovery of a novel class of drugs, CGRP functional blocking monoclonal antibodies...

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Bibliographic Details
Published in:Neurotherapeutics 2022-04, Vol.19 (3), p.922-930
Main Authors: Cohen, Fred, Yuan, Hsiangkuo, DePoy, E. M. G., Silberstein, Stephen D.
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal - pharmacology
Antibodies, Monoclonal - therapeutic use
Antineoplastic Agents, Immunological - therapeutic use
Biomedical and Life Sciences
Biomedicine
Calcitonin
Calcitonin Gene-Related Peptide
Calcitonin Gene-Related Peptide Receptor Antagonists - therapeutic use
Drug interaction
Drug therapy
Headache
Humans
Migraine
Migraine Disorders
Monoclonal antibodies
Neurobiology
Neurology
Neurosciences
Neurosurgery
Review
Toxicity
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Summary:Remarkable advancements have been made in the field of migraine pathophysiology and pharmacotherapy over the past decade. Understanding the molecular mechanism of calcitonin gene-related peptide (CGRP) has led to the discovery of a novel class of drugs, CGRP functional blocking monoclonal antibodies (mAbs), for migraine prevention. CGRP is a neuropeptide inherently involved in migraine physiology where its receptors are found dispersed throughout the central and peripheral nervous systems. CGRP-targeted mAbs are effective in the preventive treatment of both chronic and episodic migraine. The advantages of mAbs over oral migraine preventives are numerous. Favorable attributes of the mAbs include high affinity and selectivity for CGRP molecular targets, long-circulating plasma half-lives, and limited risk for nonspecific hepatic and renal toxicity. This pharmacological profile leads to fewer off-target (side) effects and drug-drug interactions rendering mAbs an attractive alternative to traditional small molecule therapies, especially for the preventive treatment of migraine. MAbs display minimal drug interaction thus are excellent for patients prescribed with multiple medications. However, the long-term safety of CGRP blockade is incompletely known, and CGRP mAbs use should be avoided during pregnancy. CGRP mAbs represent a radical shift in preventing chronic and episodic migraine.
ISSN:1933-7213
1878-7479
1878-7479
DOI:10.1007/s13311-022-01230-x