Early Experiences in Switching between Monoclonal Antibodies in Patients with Nonresponsive Migraine in Spain: A Case Series

2021 ◽  
pp. 1-4
Author(s):  
Ignacio Patier Ruiz ◽  
Javier Sánchez-Rubio Ferrández ◽  
Alba Cárcamo Fonfría ◽  
Teresa Molina García
Keyword(s):  
Clinical Trials ◽  
Monoclonal Antibodies ◽  
Therapeutic Targets ◽  
Case Series ◽  
Similar Efficacy ◽  
Migraine Prophylaxis ◽  
Therapeutic Failure ◽  
Related Peptide ◽  
Early Experiences ◽  
Calcitonin Gene

Monoclonal antibodies targeting the calcitonin gene-related peptide have been introduced into the therapeutic arsenal of migraine prophylaxis. Clinical trials report similar efficacy between them, and there is no evidence of switching to another one after failure. We aim to describe our experience in switching from erenumab to galcanezumab after therapeutic failure. We retrospectively reviewed 30 migraine patients who received monoclonal antibodies, with 15 of them switched after failure to achieve reduction in migraine days per month ≥30%. A ≥30% reduction in migraine days per month compared to baseline was observed in 8/15 (4/15 ≥ 50%) patients after switch. Some nonresponsive patients may benefit from switching between monoclonal antibodies with different therapeutic targets.

Calcitonin Gene-Related Peptide Antagonists for the Prevention of Migraine: Highlights From Pivotal Studies and the Clinical Relevance of This New Drug Class

2020 ◽  
Vol 54 (8) ◽  
pp. 795-803
Author(s):  
Karissa Arca ◽  
Jenna Reynolds ◽  
Kara A. Sands ◽  
Harn J. Shiue
Keyword(s):  
Monoclonal Antibodies ◽  
Adverse Effects ◽  
Adverse Events ◽  
Clinical Relevance ◽  
Drug Class ◽  
Calcitonin Gene Related Peptide ◽  
Migraine Prophylaxis ◽  
Related Peptide ◽  
New Drug ◽  
Calcitonin Gene

Objective: To review the new drug class of calcitonin gene-related peptide antagonists (monoclonal antibodies) and their clinical relevance in migraine prophylaxis. Data Sources: A literature search was performed in PubMed (January 2009 to November 2019) using the terms migraine, calcitonin gene-related peptide (CGRP), erenumab, fremanezumab, and galcanezumab for clinical trials and studies. Study Selection and Data Extraction: Reports from human studies in English were evaluated for clinical evidence supporting pharmacology, efficacy, and adverse events. Initial pharmacokinetic and preclinical studies were excluded. Data Synthesis: In chronic and episodic migraine, prophylaxis with injections of monoclonal antibodies antagonizing CGRP reduced monthly migraine days with minimal clinically significant adverse events. In addition, there is evidence supporting efficacy in refractory migraine despite optimal prophylaxis. Relevance to Patient Care and Clinical Practice: This is the first target-specific migraine prophylaxis treatment to show efficacy with minimal adverse effects. A higher drug cost is a barrier but is balanced by improved quality of life. Current therapies have limited efficacy and tolerability because of poor side effect profiles. CGRP antagonists represent a shift to more precise migraine treatments. Conclusions: Monoclonal antibodies inhibiting CGRP are effective in migraine prophylaxis with minimal adverse effects. Targeting CGRP is a novel clinical strategy in managing migraine.

scholarly journals Current status of calcitonin gene-related peptide-based therapies in migraine: a scoping review

2022 ◽  
Author(s):  
Marya Ahsan ◽  
Ayaz Khurram Mallick
Keyword(s):  
Clinical Trials ◽  
Monoclonal Antibodies ◽  
Small Molecule ◽  
Significant Proportion ◽  
Calcitonin Gene Related Peptide ◽  
Phase Iii ◽  
Current Status ◽  
Cgrp Receptor ◽  
Related Peptide ◽  
Calcitonin Gene

A significant proportion of patients exhibit sub-optimal response to the standard treatment of acute migraine such as triptans and NSAIDs. Even the conventional preventive therapies (e.g. beta-blockers) indicated for patients with frequent migraine attacks have varying responses. Moreover, evidence from animal studies elucidated the role of calcitonin gene-related peptide (CGRP) in the pathophysiology of migraine. Currently two classes are drug, the small molecule CGRP receptor antagonist or the ‘gepants’ (Ubrogepant, Rimegepant, Atogepant, Zavegepant) and CGRP monoclonal antibodies (Erenumab, Galcanezumab, Fremanezumab, Eptinezumab) have been found efficacious and safe in various clinical trials for the treatment and prevention of migraine. While the small molecule CGRP receptor antagonists are given orally, the monoclonal antibodies are injectable drugs. Ubrogepant and Rimegepant are the second-generation gepants approved for treatment of migraine. Zavegepant is a third generation gepant which has proven efficacy for acute treatment of migraine in a phase III trial. Atogepant has been approved for prevention of migraine. Rimegepant has also proven to be efficacious for preventing migraine attacks but has not yet been approved for this indication. Erenumab is the only monoclonal antibody which neutralizes the CGRP receptor. The latter three monoclonal antibodies target the CGRP peptide. The monoclonal antibodies have been approved for the prevention of migraine as a subcutaneously or intravenous infusion (Eptinezumab) given once a month or quarterly. Both the classes of drugs were well-tolerated in the clinical trials. Nausea was the most common adverse effect with gepants while injection-site pain was commonly reported with the antibodies.

scholarly journals Efficacy and Safety of Monoclonal Antibody Against Calcitonin Gene-Related Peptide or Its Receptor for Migraine: A Systematic Review and Network Meta-analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xing Wang ◽  
Yuqi Chen ◽  
Jinlei Song ◽  
Chao You
Keyword(s):  
Monoclonal Antibody ◽  
Clinical Trials ◽  
Monoclonal Antibodies ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Calcitonin Gene Related Peptide ◽  
Adult Patients ◽  
Related Peptide ◽  
Calcitonin Gene

Background: The optimal monoclonal antibody against calcitonin gene-related peptide (CGRP) for adult patients with migraine has yet to be determined. Therefore, we aimed to compare the effectiveness of different monoclonal antibodies against CGRP or its receptor for adult patients with migraine through a network meta-analysis of randomized controlled trials.Methods: We systematically searched the MEDILNE, Embase, ClinicalTrials.gov, and Cochrane Library databases for relevant publications from inception until October 30, 2020. Only randomized clinical trials of adults with migraine that assessed any calcitonin gene-related peptide monoclonal antibody and reported clinical outcomes were included. The primary outcomes were changes in monthly migraine days and treatment-emergent adverse eventsResults: We initially retrieved 2,070 publications, and ultimately, 18 randomized clinical trials totaling 8,926 patients were included. In terms of efficacy, eptinezumab (MD −1.43, 95% CrI −2.59 to −0.36), erenumab (MD −1.61, 95% CrI −2.40 to −0.84), fremanezumab (MD −2.19, 95% CrI −3.15 to −1.25), and galcanezumab (MD −2.10, 95% CrI −2.76 to −1.45) significantly reduced MMDs compared with placebo. In terms of safety, only galcanezumab increased the incidences of TEAEs (RR 1.11, 95% CrI 1.01–1.22) and serious adverse events (RR 2.95, 95% CrI 1.41–6.87) compared with placebo.Conclusion: Most drugs performed similarly and were superior to placebo in most of our analyses. Further head-to-head research on different types of CGRP monoclonal antibodies is necessary to validate the present findings.

Calcitonin-Gene-Related Peptide (CGRP) Monoclonal Antibodies in Migraine Prevention; Literature Review

2021 ◽  
Vol 10 (1) ◽  
pp. 48-51
Author(s):  
Haneen Ahmed Khouja ◽  
Rawan Awadh Alshehri ◽  
Hussain Mirza Alhalal ◽  
Hassan Dhafer Alabisi ◽  
Salhah Mohammad Alajmi ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Literature Review ◽  
Calcitonin Gene Related Peptide ◽  
Migraine Prevention ◽  
Related Peptide ◽  
Calcitonin Gene

scholarly journals Inflammatory complications of CGRP monoclonal antibodies: a case series

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jason C. Ray ◽  
Penelope Allen ◽  
Ann Bacsi ◽  
Julian J. Bosco ◽  
Luke Chen ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Molecular Mechanisms ◽  
Case Series ◽  
Preventive Treatment ◽  
The Body ◽  
Temporal Association ◽  
Organ Systems ◽  
Calcitonin Gene ◽  
Close Proximity ◽  
The Central Nervous System

Abstract Background Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. Cases We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. Conclusion This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.

Monoclonal antibodies distinguishing α and β forms of calcitonin gene-related peptide

1990 ◽  
Vol 134 (1) ◽  
pp. 87-94 ◽  
Author(s):  
D.P. Andrew ◽  
T.D. Bidgood ◽  
C. Bose ◽  
D. Brown ◽  
G. Galfre ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Calcitonin Gene Related Peptide ◽  
Related Peptide ◽  
Calcitonin Gene
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