Omaer Abubker, Albilali Abdulrazaq, Bamogaddam Reem, Almutairi Fares, Alsaif Raghad, Almohammadi Osama, Alhifany Abdullah A
Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia.
Neurology Unit, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Saudi Pharm J. 2024 Apr;32(4):101989. doi: 10.1016/j.jsps.2024.101989. Epub 2024 Feb 15.
Migraine is often associated with depression and anxiety, leading to a diminished quality of life. Calcitonin gene-related peptide (CGRP) antagonists have shown promise in treating migraines, but their effects on concurrent depression and anxiety have not been clarified.
A literature review was conducted on ClinicalTrials.gov, PubMed, Ovid Medline, and EMBASE focusing on phase 3 clinical trials, post-hoc analysis studies, and real-world evidence (RWE) published in the past 5 years. The review primarily utilized patient-reported outcome tools, such as the Patient Health Questionnaire-9, Hamilton Depression Rating Scale, Beck Depression Inventory-II, generalized anxiety disorder (GAD)-7, and Hamilton Anxiety Rating Scale (HARS), to assess anxiety and depression in relation to CGRP-targeted monoclonal antibodies.
Out of 260 studies, 17 met the inclusion criteria. Eptinezumab lacked sufficient evidence regarding its impact on depression and anxiety. While sufficient evidence on its effect on comorbid anxiety was not available, fremanezumab was shown to significantly improve comorbid depression in one study while not achieving statistical significance in another. Erenumab and galcanezumab showed significant improvement in comorbid depression, implying possible benefits in patients with migraine. Galcanezumab showed faster relief from depressive symptoms than other injectable CGRP antagonists. Galcanezumab also exhibited improvements in GAD-7 scores for anxiety, although not statistically significant, whereas RWE showed promising HARS scores for both galcanezumab and erenumab.
Galcanezumab and erenumab appear to be more effective in improving concurrent depressive and anxiety symptoms in migraine patients than fremanezumab. Notably, these psychometric questionnaires were not the primary outcome measures of the trials and were not specifically designed to investigate the effects of these medications on depression or anxiety. Further research is needed to fully understand the impact of CGRP antagonists on mental health disorders associated with migraines. These findings have implications for enhancing the overall well-being and quality of life in individuals with migraines and comorbid psychiatric conditions.
偏头痛常与抑郁和焦虑相关，导致生活质量下降。降钙素基因相关肽（CGRP）拮抗剂在治疗偏头痛方面已显示出前景，但其对并发的抑郁和焦虑的影响尚未明确。
在ClinicalTrials.gov、PubMed、Ovid Medline和EMBASE上进行了一项文献综述，重点关注过去5年发表的3期临床试验、事后分析研究和真实世界证据（RWE）。该综述主要使用患者报告的结局工具，如患者健康问卷-9、汉密尔顿抑郁量表、贝克抑郁量表-II、广泛性焦虑障碍（GAD）-7和汉密尔顿焦虑量表（HARS），以评估与CGRP靶向单克隆抗体相关的焦虑和抑郁。
在260项研究中，17项符合纳入标准。eptinezumab对抑郁和焦虑的影响缺乏充分证据。虽然关于其对共病焦虑的影响没有足够证据，但在一项研究中，fremanezumab被证明能显著改善共病抑郁，而在另一项研究中未达到统计学显著性。erenumab和galcanezumab在共病抑郁方面显示出显著改善，这意味着对偏头痛患者可能有益。Galcanezumab比其他注射用CGRP拮抗剂能更快缓解抑郁症状。Galcanezumab在焦虑的GAD-7评分方面也有改善，尽管未达到统计学显著性，而真实世界证据显示galcanezumab和erenumab的HARS评分都很有前景。
Galcanezumab和erenumab在改善偏头痛患者并发的抑郁和焦虑症状方面似乎比fremanezumab更有效。值得注意的是，这些心理测量问卷不是试验的主要结局指标，也不是专门设计来研究这些药物对抑郁或焦虑的影响的。需要进一步研究以充分了解CGRP拮抗剂对与偏头痛相关的精神健康障碍的影响。这些发现对于提高偏头痛和共病精神疾病患者的整体幸福感和生活质量具有重要意义。
