Efficacy of calcitonin gene-related peptide (CGRP) receptor blockers in reducing the number of monthly migraine headache days (MHDs): A network meta-analysis of randomized controlled trials

2021 ◽  
pp. 117505
Author(s):  
Ahmed Taher Masoud ◽  
Mohammed Tarek Hasan ◽  
Ahmed Sayed ◽  
Harvey Nabil Edward ◽  
Ahmed Mohamed Amer ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Migraine Headache ◽  
Meta Analysis ◽  
Calcitonin Gene Related Peptide ◽  
Controlled Trials ◽  
Cgrp Receptor ◽  
Related Peptide ◽  
Randomized Controlled ◽  
Calcitonin Gene ◽  
Receptor Blockers

scholarly journals Effect of Calcitonin Gene-Related Peptide Receptor Antagonists on Migraine Treatment: A Meta-Analysis

2021 ◽  
Author(s):  
Jiyoung Kim ◽  
Kyoungjune Pak ◽  
Gha-Hyun Lee ◽  
Jae Wook Cho ◽  
Hyun-Woo kim
Keyword(s):  
Meta Analysis ◽  
Calcitonin Gene Related Peptide ◽  
Migraine Treatment ◽  
Acute Migraine ◽  
Cgrp Receptor ◽  
Receptor Antagonists ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Cgrp Receptor Antagonists ◽  
Acute Migraine Treatment

Abstract Background: The pathophysiology of migraine has been researched incessantly, and it has been suggested that calcitonin gene-related peptide (CGRP) is associated with migraine attacks. CGRP receptor blockers are attracting attention for migraine prevention and treatment of acute episodes, and CGRP receptor antagonists have been shown to be effective in treating acute migraine headaches. This meta-analysis aimed to assess the effect of available CGRP receptor antagonists, focusing on their therapeutic doses for acute migraine treatment.Methods: We performed a systematic search of MEDLINE (from inception to March 2021) and EMBASE (from inception to March 2021) for English publications using the keywords “migraine” and “Calcitonin gene-related peptide,” limited to human studies.Results: Five studies that focused on examining the effects of CGRP receptor antagonists on acute migraine treatment met the eligibility criteria for this meta-analysis. The pooled analysis demonstrated that the CGRP receptor antagonist improved freedom from pain (OR=2.066, 95% confidence interval [CI] 1.766–2.418, I2=0%), absence of bothersome symptoms (OR=1.606, 95% CI=1.408–1.830, I2=0%), pain relief (OR=1.791, 95% CI=1.598–2.008, I2=0%), and freedom from nausea (OR=1.361, 95% CI=1.196–1.548, I2=0%), significantly more than the placebo. Conclusions: CGRP receptor antagonists are effective for acute migraine treatment and are expected to be used clinically as emerging therapeutic agents.

scholarly journals Efficacy of Calcitonin Gene-Related Peptide Antagonists in the Treatment of Acute Migraine: A Systematic Review and Meta-analysis

2019 ◽  
Vol 53 (1) ◽  
Author(s):  
Kristina M. Canlas ◽  
Regina A. Macalintal-Canlas ◽  
Fumihiko Sakai
Keyword(s):  
Pain Relief ◽  
Meta Analysis ◽  
Calcitonin Gene Related Peptide ◽  
Acute Migraine ◽  
Post Dose ◽  
Related Peptide ◽  
Randomized Controlled ◽  
Superior Efficacy ◽  
Calcitonin Gene ◽  
The Difference

Objective. This study determined the efficacy of calcitonin gene-related peptide (CGRP) antagonists in the treatment of acute migraine. Methods. Seven randomized, controlled trials were included. Outcome measures used were pain freedom and pain relief two hours after treatment. Results. The difference in pain freedom 2 hours post-dose significantly favored gepants 140/150 mg (OR=2.39, 95% CI=1.93-2.96, P<0.00001) and 280/300 mg (OR=2.94, 95% CI=2.44-3.35, P<0.00001) over placebo, while the difference in pain freedom 2 hours post- dose did not significantly favor triptans over gepants 140/150 mg and vice versa (OR=0.62, 95% CI=0.32-1.21, P=0.16) and over gepants 280/300 mg (OR=0.86, 95% CI=0.64-1.15, P=0.34). The difference in pain relief 2 hours post-dose significantly favored gepants 140/150 mg (OR=2.49, 95% CI=2.13-2.91, P<0.00001) and 280/300 mg (OR=2.78, 95% CI=2.41-3.21, P<0.00001) over placebo. The difference in pain relief 2 hours post-dose significantly favored triptans over gepants 140/150 mg (OR=0.73, 95% CI=0.56-0.96, P=0.03), but not over gepants 280/300 mg and vice versa (OR=0.98, 95% CI=0.76-1.27, P=0.89). Conclusion. With regard to pain freedom and pain relief two hours post-dose, CGRP antagonists are more efficacious than placebo in the treatment of acute migraine but there is insufficient evidence to demonstrate superior efficacy of CGRP antagonists over triptans.

A Review of the Potential Receptors of Migraine with a Special Emphasis on CGRP to Develop an Ideal Antimigraine Drug

2020 ◽  
Vol 14 (1) ◽  
pp. 11-26
Author(s):  
Krishna P. Naduchamy ◽  
Varadarajan Parthasarathy
Keyword(s):  
Migraine Headache ◽  
Transient Receptor Potential ◽  
Calcitonin Gene Related Peptide ◽  
Present Review ◽  
Transient Receptor Potential Vanilloid ◽  
Cgrp Receptor ◽  
Target Proteins ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Study Results

Background and Objective: Migraine is a neurovascular syndrome associated with unilateral, throbbing headache accompanied with nausea, vomiting and photo/phonophobia. Several proteins are involved in the etiopathogenesis of migraine headache. The aim of the present review is to give an insight into the various target proteins involved in migraine headache pertaining to the development of a potential anti-migraine drug molecule. Proteins/receptors such as serotonin (5-HT), Calcitonin Gene Related Peptide (CGRP), Transient Receptor Potential Vanilloid (TRPV1), cannabinoid, glutamate, opioid and histamine receptors play various roles in migraine. The nature of the proteins, their types, binding partner membrane proteins and the consequences of the reactions produced have been discussed. The studies conducted on animals and humans with the above mentioned target proteins/receptors and the results obtained have also been reviewed. Conclusion: Calcitonin Gene Related Peptide (CGRP), a G protein coupled receptor (GPCR) significantly contributed to the progression of migraine. CGRP antagonist inhibits the release of CGRP from trigeminal neurons of trigeminal ganglion. Based on the study results, the present review suggests that the inhibition of CGRP receptor might be a successful way to treat migraine headache. Currently, researchers across the world are focussing their attention towards the development of novel molecules to treat migraine headache by targeting CGRP receptor which can be attributed to its specificity among the several proteins involved in migraine.

scholarly journals Calcitonin Gene-Related Peptide Monoclonal Antibodies Versus Botulinum Neurotoxin a in the Preventive Treatment of Chronic Migraine: An Adjusted Indirect Treatment Comparison Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yao-Yao Chen ◽  
Xiao-Qian Ye ◽  
Tai-Chun Tang ◽  
Tian-Wei She ◽  
Min Chen ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Botulinum Neurotoxin ◽  
Meta Analysis ◽  
Preventive Treatment ◽  
Calcitonin Gene Related Peptide ◽  
Controlled Trials ◽  
Botulinum Neurotoxin A ◽  
Related Peptide ◽  
Calcitonin Gene

Purpose: Calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) are new agents approved by the US Food and Drug Administration for preventive treatment of chronic migraine. Comparison between CGRPmAbs and previously approved Botulinum neurotoxin A (BoNT-A) will inform optimal preventive treatment of chronic migraine, but head-to-head trials are lacking. We therefore aimed to perform adjusted indirect comparison between CGRPmAbs and BoNT-A through a meta-analysis.Methods: OVID MEDLINE, EMBASE and the Cochrane central register of controlled trials, clinical registries, and government websites were searched from inception to September 2019. Randomized controlled trials comparing CGRPmAbs or BoNT-A with placebo in the preventive treatment of chronic migraine were included. The primary outcomes were headache days and migraine days measured at week 12. Data were synthesized by using a frequentist approach; and the treatments were ranked by P-score.Results: We included 10 trials (n = 4,678) after screening 1049 candidates. Six trials were with low risk of bias. Fremanezumab had an effect similar to BoNT-A in the reduction of headache days at week 12 (standard mean difference [SMD] 0.08, 95%CI -0.55 to -0.7). Galcanezumab reduced more migraine days than BoNT-A at week 12 (SMD, -0.94, 95%CI −1.24 to −0.63); fremanezumab showed similar findings (SMD, −0.55, 95%CI −0.85 to −0.24). Galcanezumab and fremanezumab had better effect in mitigating headache impact at week 12. CGRPmAbs and BoNT-A had similar adverse event rate.Conclusion: CGRPmAbs and BoNT-A had similar effect in the preventive treatment of chronic migraine. BoNT-A might be preferentially selected owing to its cost-effectiveness profiles. Further studies with direct comparison of the two treatments are warranted.

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