Department of Biotechnological and Applied Clinical Sciences - University of L'Aquila, Via Vetoio 1, L'Aquila, Italy.
Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark.
J Headache Pain. 2022 Jun 11;23(1):67. doi: 10.1186/s10194-022-01431-x.
A previous European Headache Federation (EHF) guideline addressed the use of monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway to prevent migraine. Since then, randomized controlled trials (RCTs) and real-world evidence have expanded the evidence and knowledge for those treatments. Therefore, the EHF panel decided to provide an updated guideline on the use of those treatments.
The guideline was developed following the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed a systematic review and an analysis of the literature, assessed the quality of the available evidence, and wrote recommendations. Where the GRADE approach was not applicable, expert opinion was provided.
We found moderate to high quality of evidence to recommend eptinezumab, erenumab, fremanezumab, and galcanezumab in individuals with episodic and chronic migraine. For several important clinical questions, we found not enough evidence to provide evidence-based recommendations and guidance relied on experts' opinion. Nevertheless, we provided updated suggestions regarding the long-term management of those treatments and their place with respect to the other migraine preventatives.
Monoclonal antibodies targeting the CGRP pathway are recommended for migraine prevention as they are effective and safe also in the long-term.
欧洲头痛联合会（EHF）之前的指南讨论了使用靶向降钙素基因相关肽（CGRP）通路的单克隆抗体预防偏头痛。此后，随机对照试验（RCT）和真实世界证据扩展了这些治疗方法的证据和知识。因此，EHF 小组决定提供这些治疗方法的更新指南。
该指南是按照推荐评估、制定与评价分级（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。在不适用 GRADE 方法的情况下，提供了专家意见。
我们发现中等至高质量的证据支持在发作性和慢性偏头痛患者中使用依替替扎单抗、雷那珠单抗、夫罗曲坦和加巴喷丁。对于一些重要的临床问题，我们发现没有足够的证据提供基于证据的建议，并且依赖于专家的意见。然而，我们就这些治疗方法的长期管理以及它们在其他偏头痛预防药物中的地位提供了更新的建议。
靶向 CGRP 通路的单克隆抗体可用于预防偏头痛，因为它们在长期治疗中也是有效且安全的。
