Danish Headache Center, Dept. of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Cephalalgia. 2019 Mar;39(3):374-389. doi: 10.1177/0333102417741297. Epub 2017 Nov 7.
Migraine and cluster headache are challenging to manage, with no tailored preventive medications available. Targeting the calcitonin gene-related peptide (CGRP) pathway to treat these headaches may be the first focused therapeutic option to date, with the potential for promising efficacy.
We systematically searched PubMed and clinicaltrials.gov for randomized controlled trials investigating the preventive potential of monoclonal antibodies against the CGRP pathway in the treatment of migraine and cluster headache.
The literature search returned a total of 136 records, of which 32 were eligible for review.
Clinical data from phase II and III trials of the four monoclonal antibodies targeting the CGRP pathway: Eptinezumab, erenumab, fremanezumab, and galcanezumab, collectively show a positive effect in the preventive treatment of episodic and chronic migraine. Multiple phase II and III trials are under way to further determine the efficacy and safety of this new drug class. It may be particularly important to assess the cardiovascular effects of long-term CGRP blockade. Phase III trials are also currently in progress for the preventive treatment of cluster headache.
Efficacy of anti-CGRP monoclonal antibodies spells a promising future for the many patients suffering from migraine, and possibly also for the smaller but severely-affected population with cluster headache.
偏头痛和丛集性头痛的治疗极具挑战性，目前尚无针对性的预防药物。靶向降钙素基因相关肽（CGRP）通路治疗这些头痛可能是迄今为止第一个具有潜在疗效的靶向治疗选择。
我们系统地在 PubMed 和 clinicaltrials.gov 上搜索了针对偏头痛和丛集性头痛治疗中 CGRP 通路单克隆抗体预防潜力的随机对照试验。
文献检索共返回 136 条记录，其中 32 条符合审查标准。
针对 CGRP 通路的四种单克隆抗体（eptinezumab、erenumab、fremanezumab 和 galcanezumab）的 II 期和 III 期临床试验的临床数据表明，它们在预防治疗发作性和慢性偏头痛方面具有积极作用。多项 II 期和 III 期试验正在进行中，以进一步确定这种新药类别的疗效和安全性。评估长期 CGRP 阻断的心血管影响可能尤为重要。预防治疗丛集性头痛的 III 期试验也正在进行中。
抗 CGRP 单克隆抗体的疗效为众多偏头痛患者带来了充满希望的未来，对于患有丛集性头痛的人数较少但病情严重的患者也可能如此。
