Moisset Xavier, Demarquay Geneviève
Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France.
Hôpital neurologique, Hospices civils de Lyon, NeuroPain Lab, Inserm U1028, CNRS UMR5292, Lyon Neuroscience Research Center, université Claude- Bernard Lyon-1, France.
Rev Prat. 2023 Feb;73(2):123-126.
ANTI-CALCITONIN GENE-RELATED PEPTIDE (CGRP) THERAPIES FOR MIGRAINE. Currently, four monoclonal antibodies targeting the CGRP (calcitonin gene-related peptide) pathway have been shown to be effective as migraine prophylactics: eptinezumab, erenumab, fremanezumab and galcanezumab. Unlike the usual preventive treatments, they are administered parenterally: subcutaneously (monthly or quarterly) or by quarterly IV infusion for eptinezumab. They reduce the frequency of attacks by at least 50% in 50 to 60% of migraine patients, even in cases of failure of several conventional preventive treatments, in cases of chronic migraine and medication overuse. Their tolerance is better than that of conventional oral treatments and the discontinuation rates are very low. They can be proposed after failure of at least two conventional prophylactic treatments, in patients with at least 8 migraine days per month and without cardiovascular pathology. Indeed, these drugs present a risk in case of cardiovascular disease, by inhibiting vasodilation, and are therefore contraindicated in this population. The main limitation to the use of these treatments in France at present is the lack of reimbursement, the cheapest molecule being available at a price of 245 € per injection.
用于偏头痛的抗降钙素基因相关肽（CGRP）疗法。目前，四种靶向CGRP（降钙素基因相关肽）途径的单克隆抗体已被证明作为偏头痛预防性药物有效：依普奈珠单抗、erenumab、夫瑞奈珠单抗和加卡奈珠单抗。与常规预防性治疗不同，它们通过肠胃外给药：皮下注射（每月或每季度一次），依普奈珠单抗则每季度静脉输注一次。在50%至60%的偏头痛患者中，它们将发作频率降低至少50%，即使在几种常规预防性治疗失败的情况下、慢性偏头痛和药物过度使用的情况下也是如此。它们的耐受性优于常规口服治疗，停药率非常低。在至少两种常规预防性治疗失败后，对于每月至少有8个偏头痛日且无心血管疾病的患者，可以使用这些药物。事实上，这些药物在心血管疾病患者中存在抑制血管舒张的风险，因此该人群禁用。目前在法国使用这些治疗方法的主要限制是缺乏报销，最便宜的药物每注射一次价格为245欧元。
