Headache Outpatient Clinic, Department of Neurology, 'Agios Andreas' State General Hospital of Patras, Patras, Greece.
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Expert Rev Neurother. 2022 Jun;22(6):469-488. doi: 10.1080/14737175.2022.2091435. Epub 2022 Jun 27.
Gepants are small molecules targeting the calcitonin gene-related peptide (CGRP) that have been recently introduced and are under additional clinical development as preventive and abortive treatment options for migraine.
After providing a narrative overview of current preventive and acute treatment options for migraine and summarizing the pathophysiology of migraine attack and the role of CGRP, we performed a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on trials on gepants in preventive and acute treatment of migraine. Studies and results were reviewed and discussed, and expert opinion was presented. We also collected data on relevant ongoing trials.
Whether direct targeting CGRP pathways within the central nervous system or indirectly modulating them from the peripheral nervous system is more effective and safer in migraine remains still unclear. The available data on the efficacy and safety of gepants suggest they may represent an abortive, and to some extent, preventive treatment option for migraine, in patients who do not respond or have adverse effects to first/second line treatments or at high risk for medication overuse headache; thus opening new therapeutic horizons.
Gepants 是一种针对降钙素基因相关肽（CGRP）的小分子药物，最近已被引入并正在进行额外的临床开发，作为偏头痛的预防和中止治疗选择。
在提供偏头痛当前预防和急性治疗选择的叙述性概述，并总结偏头痛发作的病理生理学和 CGRP 的作用后，我们根据系统评价和荟萃分析的首选报告项目（PRISMA）建议，对 gepants 在偏头痛预防和急性治疗中的试验进行了系统评价。对研究和结果进行了审查和讨论，并提出了专家意见。我们还收集了有关正在进行的试验的数据。
直接靶向中枢神经系统内的 CGRP 途径，还是从周围神经系统间接调节它们，在偏头痛中更有效和更安全，目前仍不清楚。关于 gepants 的疗效和安全性的现有数据表明，对于对一线/二线治疗无反应或有不良反应或有药物过度使用性头痛高风险的患者，它们可能代表一种中止治疗，并且在一定程度上是预防偏头痛的治疗选择；从而开辟了新的治疗前景。
