Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?

Detalhes bibliográficos
Autor(a) principal: Simioni,Caio Vinicius de Meira Grava
Data de Publicação: 2022
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos de neuro-psiquiatria (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700214
Resumo: ABSTRACT Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don’t seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.
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spelling Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?Antibodies, MonoclonalCosts and Cost AnalysisEfficacyHealth Services Needs and DemandMigraine DisordersHeadachePharmaceutical PreparationsPrescriptionsSafetySurveillanceTherapeuticsABSTRACT Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don’t seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.Academia Brasileira de Neurologia - ABNEURO2022-05-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700214Arquivos de Neuro-Psiquiatria v.80 n.5 suppl.1 2022reponame:Arquivos de neuro-psiquiatria (Online)instname:Academia Brasileira de Neurologiainstacron:ABNEURO10.1590/0004-282x-anp-2022-s125info:eu-repo/semantics/openAccessSimioni,Caio Vinicius de Meira Gravaeng2022-08-16T00:00:00Zoai:scielo:S0004-282X2022000700214Revistahttp://www.scielo.br/anphttps://old.scielo.br/oai/scielo-oai.php||revista.arquivos@abneuro.org1678-42270004-282Xopendoar:2022-08-16T00:00Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologiafalse
dc.title.none.fl_str_mv Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
title Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
spellingShingle Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
Simioni,Caio Vinicius de Meira Grava
Antibodies, Monoclonal
Costs and Cost Analysis
Efficacy
Health Services Needs and Demand
Migraine Disorders
Headache
Pharmaceutical Preparations
Prescriptions
Safety
Surveillance
Therapeutics
title_short Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
title_full Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
title_fullStr Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
title_full_unstemmed Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
title_sort Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?
author Simioni,Caio Vinicius de Meira Grava
author_facet Simioni,Caio Vinicius de Meira Grava
author_role author
dc.contributor.author.fl_str_mv Simioni,Caio Vinicius de Meira Grava
dc.subject.por.fl_str_mv Antibodies, Monoclonal
Costs and Cost Analysis
Efficacy
Health Services Needs and Demand
Migraine Disorders
Headache
Pharmaceutical Preparations
Prescriptions
Safety
Surveillance
Therapeutics
topic Antibodies, Monoclonal
Costs and Cost Analysis
Efficacy
Health Services Needs and Demand
Migraine Disorders
Headache
Pharmaceutical Preparations
Prescriptions
Safety
Surveillance
Therapeutics
description ABSTRACT Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don’t seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.
publishDate 2022
dc.date.none.fl_str_mv 2022-05-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700214
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1590/0004-282x-anp-2022-s125
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dc.publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
dc.source.none.fl_str_mv Arquivos de Neuro-Psiquiatria v.80 n.5 suppl.1 2022
reponame:Arquivos de neuro-psiquiatria (Online)
instname:Academia Brasileira de Neurologia
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reponame_str Arquivos de neuro-psiquiatria (Online)
collection Arquivos de neuro-psiquiatria (Online)
repository.name.fl_str_mv Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologia
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