Headache Research Unit, Department of Neurology‑Citadelle Hospital, University of Liège, Boulevard du 12 ème de Ligne 1, Liège, 4000, Belgium.
Department of Neurology, General Hospital Sint-Jan Bruges, Ruddershove 10, Bruges, 8000, Belgium.
J Headache Pain. 2023 Aug 1;24(1):99. doi: 10.1186/s10194-023-01637-7.
The monoclonal antibodies (mAbs) blocking the calcitonin-gene related peptide (CGRP) pathway, collectively called here "anti-CGRP/rec mAbs", have dramatically improved preventive migraine treatment. Although their efficacy and tolerability were proven in a number of randomized controlled trials (RCTs) and, maybe even more convincingly, in real world settings, a number of open questions remain. In this narrative review, we will analyze published data allowing insight in some of the uncertainties related to the use of anti-CGRP/rec mAbs in clinical practice: their differential efficacy in migraine subtypes, outcome predictors, switching between molecules, use in children and adolescents, long-term treatment adherence and persistence, effect persistence after discontinuation, combined treatment with botulinum toxin or gepants, added-value and cost effectiveness, effectiveness in other headache types, and potential contraindications based on known physiological effects of CGRP. While recent studies have already provided hints for some of these questions, many of them will not find reliable and definitive answers before larger studies, registries or dedicated RCTs are available.
阻断降钙素基因相关肽 (CGRP) 通路的单克隆抗体（mAbs），在这里统称为“抗 CGRP/受体 mAbs”，已极大地改善了预防性偏头痛治疗。尽管它们的疗效和耐受性已在多项随机对照试验 (RCT) 中得到证实，也许更有说服力的是在真实世界环境中得到证实，但仍存在一些悬而未决的问题。在本叙述性综述中，我们将分析已发表的数据，深入了解与抗 CGRP/受体 mAbs 在临床实践中的使用相关的一些不确定性：它们在偏头痛亚型中的疗效差异、结局预测因素、分子间的转换、在儿童和青少年中的使用、长期治疗的依从性和持久性、停药后的效果持续时间、与肉毒杆菌毒素或 gepants 的联合治疗、附加值和成本效益、在其他头痛类型中的疗效，以及基于 CGRP 已知生理作用的潜在禁忌症。虽然最近的研究已经为其中一些问题提供了线索，但在更大规模的研究、登记处或专门的 RCT 可用之前，许多问题仍无法得到可靠和明确的答案。
