Continuum (Minneap Minn). 2024 Apr 1;30(2):364-378. doi: 10.1212/CON.0000000000001418.
This article describes strategies for the preventive treatment of migraine including the emerging role of calcitonin gene-related peptide (CGRP)-targeted therapies and introduces novel paradigms for the preventive treatment of migraine.
Multiple migraine medications targeting CGRP have been introduced since 2018, including injectable monoclonal antibodies (ie, eptinezumab, erenumab, fremanezumab, and galcanezumab) and oral small-molecule CGRP receptor antagonists (ie, ubrogepant, rimegepant, atogepant, and zavegepant). With the exceptions of ubrogepant and zavegepant, which are approved only as acute treatments, all of these agents have demonstrated efficacy in the preventive treatment of migraine; the monoclonal antibodies and atogepant have evidence of effectiveness in adults with either episodic or chronic migraine. The safety and tolerability profiles of CGRP-targeted therapies in migraine are favorable.
The goals of preventive migraine therapy include reducing the frequency, severity, duration, and disability associated with attacks, reducing the need for acute treatment and the risk of medication overuse, enhancing self-efficacy and health-related quality of life, and reducing headache-related distress and interictal burden. Six drugs targeting CGRP (four monoclonal antibodies and two gepants) are now available for the preventive treatment of episodic migraine in adults. The efficacy of CGRP-targeted medications in the acute and preventive treatment of migraine, together with good safety and tolerability, has led to the emergence of new approaches to preventive treatment.
本文介绍偏头痛预防治疗策略，包括降钙素基因相关肽（CGRP）靶向治疗的新进展，并介绍偏头痛预防治疗的新方法。
自 2018 年以来，已有多种针对 CGRP 的偏头痛药物问世，包括注射用单克隆抗体（如依替利珠单抗、埃普奈单抗、雷美替胺和加奈替胺）和口服小分子 CGRP 受体拮抗剂（如ubrogepant、rimegepant、atogepant 和 zavegepant）。除 ubrogepant 和 zavegepant 仅被批准用于急性治疗外，所有这些药物在偏头痛预防治疗中均显示出疗效；单克隆抗体和 atogepant 均有证据表明对有或无先兆偏头痛的成人有效。CGRP 靶向治疗偏头痛的安全性和耐受性良好。
预防性偏头痛治疗的目标包括减少发作的频率、严重程度、持续时间和相关残疾，减少急性治疗和药物滥用的风险，增强自我效能和健康相关生活质量，以及减少头痛相关的痛苦和发作间负担。目前有 6 种靶向 CGRP 的药物（4 种单克隆抗体和 2 种 gepants）可用于成人偏头痛的预防性治疗。CGRP 靶向药物在偏头痛的急性和预防性治疗中的疗效，加上良好的安全性和耐受性，催生了预防治疗的新方法。
