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Review
.2017 Nov;6(6):534-547.
doi: 10.1002/cpdd.345. Epub 2017 Apr 14.

Spotlight on Anti-CGRP Monoclonal Antibodies in Migraine: The Clinical Evidence to Date

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Review

Spotlight on Anti-CGRP Monoclonal Antibodies in Migraine: The Clinical Evidence to Date

Lanfranco Pellesi et al. Clin Pharmacol Drug Dev.2017 Nov.

Abstract

Migraine, a common neurovascular brain disorder, represents a severe and widespread health problem; along with medication-induced (medication-overuse) headache, it is the third-leading cause of disability worldwide. Currently, its therapeutic management remains unsatisfactory for several reasons; up to 40% of migraineurs are eligible for prophylactic treatment, but there are issues of efficacy, safety, and adherence. In recent years the evidence on the role of calcitonin gene-related peptide (CGRP) in migraine pathophysiology has been consolidated, so new and promising treatments for migraine pain and its possible prevention have been developed. The following review reports the results of the clinical trials conducted so far with each of the new monoclonal antibodies targeting CGRP or its receptor, with particular reference to safety, tolerance, and efficacy in migraine prevention. Moreover, the pharmacological characterization and further developments of each monoclonal antibody are reported, based on current knowledge.

Keywords: CGRP; immunotherapy; migraine; monoclonal antibodies; prophylaxis.

© 2017 The Authors. Clinical Pharmacology in Drug Development published by Wiley Periodicals, Inc. on behalf of The American College of Clinical Pharmacology.

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Figures

Figure 1
Figure 1
Illustrative representation of calcitonin gene–related peptide (CGRP) activity in the absence and/or in the presence of anti‐CGRP mAbs. (1) In normal conditions, CGRP (little green balls) binds usually its receptor. (2) When the CGRP is neutralized by a monoclonal antibody, other peptides (blue pentagons) may potentially interact with the CGRP main receptor. (3) When the CGRP main receptor is blocked by a monoclonal antibody, it is impeded by any receptor interaction. CGRP and other peptides can alternatively still bind other receptors, for which they have affinity.
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