Krymchantowski Abouch V, Krymchantowski Ana Gabriela Ferreira, Jevoux Carla da Cunha
Centro de Avaliação e Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil.
Arq Neuropsiquiatr. 2019 Feb;77(2):115-121. doi: 10.1590/0004-282X20190004.
Migraine is a burdensome disorder. Current treatments are far from ideal. Recent knowledge has been indicating targets whose antagonism may improve efficacy. It is particularly true with the calcitonin gene-related peptide (CGRP) and the monoclonal antibodies anti-CGRP can interfere with this pathway and decrease the frequency of migraine attacks. Erenumab, fremanezumab and galcanezumab have recently been approved and eptinezumab is likely to be, soon. Although efficacy figures were not spectacular, tolerability and potential higher adherence were noteworthy. However, caution must be exercised. The time frame after the studies was limited to three years and dose administration was restricted to three-monthly doses. The CGRP is present throughout the human body and migraine is a life-long disease, often requiring treatment for decades. It is not known whether this favorable profile can be maintained or will be safe in pregnant women or adolescents. In addition, there were deaths during the studies, which may have happened without a clear relationship. New treatments are welcome, but caution is warranted.
偏头痛是一种负担沉重的疾病。目前的治疗方法远非理想。最近的研究表明，一些靶点的拮抗作用可能会提高疗效。降钙素基因相关肽（CGRP）尤其如此，抗CGRP单克隆抗体可干扰该途径并降低偏头痛发作的频率。依瑞奈尤单抗、夫雷奈尤单抗和加卡奈尤单抗最近已获批准，eptinezumab可能也即将获批。尽管疗效数据并不惊人，但耐受性和可能更高的依从性值得注意。然而，必须谨慎行事。研究后的时间框架仅限于三年，给药剂量限于每三个月一次。CGRP存在于人体全身，而偏头痛是一种终身疾病，通常需要数十年的治疗。目前尚不清楚这种良好的情况在孕妇或青少年中是否能够维持或是否安全。此外，研究期间有死亡病例，可能与药物并无明确关联。新的治疗方法是受欢迎的，但谨慎是必要的。
