Blocking CGRP in migraine patients â a review of pros and cons

Simone Vigneri, Laura Papetti, Eloisa Rubio-Beltrán, Katharina Kamm, Marie Deen, Tim Kelderman, Antoinette Maassen Van Den Brink, Lars Edvinsson, Edvige Correnti

    Risultato della ricerca: Review article

    56 Citazioni (Scopus)

    Abstract

    Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceeds the cons.
    Lingua originaleEnglish
    pagine (da-a)96-
    Numero di pagine9
    RivistaDefault journal
    Volume18
    Stato di pubblicazionePublished - 2017

    Fingerprint

    Calcitonin Gene-Related Peptide
    Migraine Disorders
    Calcitonin Gene-Related Peptide Receptors
    Pharmaceutical Preparations
    Physiological Phenomena
    Pituitary Hormones
    Peripheral Nervous System
    Constipation
    Transaminases
    Nervous System Diseases
    Wound Healing
    Comorbidity
    Epilepsy
    Cardiovascular Diseases
    Central Nervous System
    Monoclonal Antibodies
    Placebos
    Hypertension
    Safety
    Antibodies

    All Science Journal Classification (ASJC) codes

    • Clinical Neurology
    • Anesthesiology and Pain Medicine

    Cita questo

    Vigneri, S., Papetti, L., Rubio-Beltrán, E., Kamm, K., Deen, M., Kelderman, T., ... Correnti, E. (2017). Blocking CGRP in migraine patients â a review of pros and cons. Default journal, 18, 96-.

    Blocking CGRP in migraine patients â a review of pros and cons. / Vigneri, Simone; Papetti, Laura; Rubio-Beltrán, Eloisa; Kamm, Katharina; Deen, Marie; Kelderman, Tim; Maassen Van Den Brink, Antoinette; Edvinsson, Lars; Correnti, Edvige.

    In: Default journal, Vol. 18, 2017, pag. 96-.

    Risultato della ricerca: Review article

    Vigneri, S, Papetti, L, Rubio-Beltrán, E, Kamm, K, Deen, M, Kelderman, T, Maassen Van Den Brink, A, Edvinsson, L & Correnti, E 2017, 'Blocking CGRP in migraine patients â a review of pros and cons', Default journal, vol. 18, pagg. 96-.
    Vigneri S, Papetti L, Rubio-Beltrán E, Kamm K, Deen M, Kelderman T e altri. Blocking CGRP in migraine patients â a review of pros and cons. Default journal. 2017;18:96-.
    Vigneri, Simone ; Papetti, Laura ; Rubio-Beltrán, Eloisa ; Kamm, Katharina ; Deen, Marie ; Kelderman, Tim ; Maassen Van Den Brink, Antoinette ; Edvinsson, Lars ; Correnti, Edvige. / Blocking CGRP in migraine patients â a review of pros and cons. In: Default journal. 2017 ; Vol. 18. pagg. 96-.
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    title = "Blocking CGRP in migraine patients {\^a} a review of pros and cons",
    abstract = "Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceeds the cons.",
    keywords = "Acute treatment, Anesthesiology and Pain Medicine, Cgrp, Cgrp receptor, Gepants, Migraine, Neurology (clinical), Prophylactic treatment",
    author = "Simone Vigneri and Laura Papetti and Eloisa Rubio-Beltr{\'a}n and Katharina Kamm and Marie Deen and Tim Kelderman and {Maassen Van Den Brink}, Antoinette and Lars Edvinsson and Edvige Correnti",
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    T1 - Blocking CGRP in migraine patients â a review of pros and cons

    AU - Vigneri, Simone

    AU - Papetti, Laura

    AU - Rubio-Beltrán, Eloisa

    AU - Kamm, Katharina

    AU - Deen, Marie

    AU - Kelderman, Tim

    AU - Maassen Van Den Brink, Antoinette

    AU - Edvinsson, Lars

    AU - Correnti, Edvige

    PY - 2017

    Y1 - 2017

    N2 - Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceeds the cons.

    AB - Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceeds the cons.

    KW - Acute treatment

    KW - Anesthesiology and Pain Medicine

    KW - Cgrp

    KW - Cgrp receptor

    KW - Gepants

    KW - Migraine

    KW - Neurology (clinical)

    KW - Prophylactic treatment

    UR - http://hdl.handle.net/10447/255474

    M3 - Review article

    VL - 18

    SP - 96-

    JO - Default journal

    JF - Default journal

    ER -