Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy.
Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Headache Pain. 2019 Jan 16;20(1):6. doi: 10.1186/s10194-018-0955-y.
Monoclonal antibodies acting on the calcitonin gene-related peptide or on its receptor are new drugs to prevent migraine. Four monoclonal antibodies have been developed: one targeting the calcitonin gene-related peptide receptor (erenumab) and three targeting the calcitonin gene-related peptide (eptinezumab, fremanezumab, and galcanezumab). The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based guideline on the use of the monoclonal antibodies acting on the calcitonin gene-related peptide for migraine prevention.
The guideline was developed following the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed systematic review and analysis of the literature, assessed the quality of available evidence, and wrote recommendations. Where the GRADE approach was not applicable, expert opinion was provided.
We found low to high quality of evidence to recommend eptinezumab, erenumab, fremanezumab, and galcanezumab in patients with episodic migraine and medium to high quality of evidence to recommend erenumab, fremanezumab, and galcanezumab in patients with chronic migraine. For several clinical questions, there was not enough evidence to provide recommendations using the GRADE approach and recommendations relied on experts' opinion.
Monoclonal antibodies acting on the calcitonin gene-related peptide are new drugs which can be recommended for migraine prevention. Real life data will be useful to improve the use of those drugs in clinical practice.
作用于降钙素基因相关肽或其受体的单克隆抗体是预防偏头痛的新药。已经开发了四种单克隆抗体：一种针对降钙素基因相关肽受体（erenumab），三种针对降钙素基因相关肽（eptinezumab、fremanezumab 和 galcanezumab）。本文由欧洲头痛联合会（EHF）撰写，旨在提供关于使用作用于降钙素基因相关肽的单克隆抗体预防偏头痛的循证和专家指南。
该指南是按照推荐分级评估、制定与评价（GRADE）方法制定的。工作组确定了相关问题，进行了系统评价和文献分析，评估了现有证据的质量，并撰写了建议。在 GRADE 方法不适用的情况下，提供了专家意见。
我们发现，对于发作性偏头痛患者，有低到高质量的证据推荐使用 eptinezumab、erenumab、fremanezumab 和 galcanezumab；对于慢性偏头痛患者，有中到高质量的证据推荐使用 erenumab、fremanezumab 和 galcanezumab。对于一些临床问题，没有足够的证据使用 GRADE 方法提供建议，因此建议依赖于专家意见。
作用于降钙素基因相关肽的单克隆抗体是预防偏头痛的新药。真实世界的数据将有助于改善这些药物在临床实践中的应用。
