1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Curr Opin Neurol. 2022 Jun 1;35(3):353-359. doi: 10.1097/WCO.0000000000001061.
Medication overuse headache (MOH) affects more than 60 million individuals worldwide causing enormous personal and social burden. Only repurposed drugs are available for MOH that share limited evidence for efficacy. The preclinical data suggesting that activation of the calcitonin gene-related peptide (CGRP) pathway is involved in headache chronification along with clinical evidence that monoclonal antibodies targeting CGRP (anti-CGRP mAbs) have good efficacy in preventing chronic migraine, triggered this review that aims to summarize the current data on the effectiveness and safety of mAbs against CGRP in MOH.
Post hoc analyses of phase-3 trials of erenumab, fremanezumab, galcanezumab, and eptinezumab for the prevention of chronic migraine revealed that patients with MOH benefit from the treatment over placebo. Several real-world studies confirm the efficacy of erenumab and galcanezumab in patients with MO. However, all published trials evaluated treatments in patients with chronic migraine with MO collectively, not in patients with MOH exclusively.
The available data indicate that anti-CGRP mAbs represent a good mechanism-based and disease-specific therapeutical option with for MOH as long as detoxification and additional nonpharmaceutical interventions are operated. Future research should focus on long-term-controlled trials in MOH populations exclusively.
综述目的：药物过度使用性头痛（MOH）影响全球超过 6000 万人，给个人和社会带来了巨大负担。MOH 仅可使用重新定位的药物，这些药物的疗效证据有限。临床前数据表明，降钙素基因相关肽（CGRP）通路的激活与头痛慢性化有关，而靶向 CGRP 的单克隆抗体（抗 CGRP mAbs）在预防慢性偏头痛方面具有良好疗效的临床证据，激发了本次综述，旨在总结 CGRP 拮抗剂在 MOH 中的有效性和安全性的现有数据。
最新发现：依那西普、氟雷马尼布、加兰尼布和依替尼布预防慢性偏头痛的 3 期试验的事后分析显示，MOH 患者从治疗中获益优于安慰剂。几项真实世界研究证实了依那西普和加兰尼布在 MO 患者中的疗效。然而，所有已发表的试验均评估了联合治疗慢性偏头痛伴 MOH 患者的药物，而非单独评估 MOH 患者。
总结：现有数据表明，抗 CGRP mAbs 代表了一种良好的基于机制和针对疾病的治疗选择，只要进行解毒和额外的非药物干预。未来的研究应专注于 MOH 人群的长期对照试验。
