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Neurological Sciences

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20-06-2022 | Migraine | Review Article

The ultimate guide to the anti-CGRP monoclonal antibodies galaxy

Authors: Davide Mascarella, Eleonora Matteo, Valentina Favoni, Sabina Cevoli

Published in: Neurological Sciences | Issue 9/2022

Abstract

Background

Anti-CGRP monoclonal antibodies have represented a real revolution in the field of headaches, being the result of an extraordinary process of translation of new pathophysiological discoveries into successful therapies. Nonetheless, clinical practice is far more complex than pivotal trials setting, and real-world studies are blooming to deepen knowledge of these revolutionary medications.

Objective

To provide an updated guide for evidence-based clinical practice.

Methods

Pivotal phase 3 randomised clinical trials for each anti-CGRP(-R) monoclonal antibody were considered. We evaluated prospective real-world studies and summarised evidence on anti-CGRP mAbs use beyond episodic and chronic migraine.

Results

All phase 3 RCTs showed an unprecedented profile of efficacy and safety in migraine prevention for the four anti-CGRP mAbs. However, plenty of questions remained open after the approval process. Real-world studies filled the gap and effectiveness results equalled or unexpectedly outperformed RCTs figures in most cases; safety results showed a lower incidence of adverse events, but a higher frequency of reported constipation compared to RCTs. Almost all studies displayed a rapid and progressive headache worsening following treatment suspension. Several positive response predictors were suggested, such as unilateral pain, allodynia in episodic migraineurs, response to triptans, and a lower number of failed prophylaxes. Comparable effectiveness was observed in resistant/refractory patients. In medication overuse headache patients, a clear clinical benefit was observed irrespective of any possible detoxification program.

Conclusions

Our narrative review restates the remarkable efficacy, effectiveness, and safety profile in both RCTs and real-world settings and provides scientific evidence for clinical practice.

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Title: The ultimate guide to the anti-CGRP monoclonal antibodies galaxy
Authors: Davide Mascarella
Eleonora Matteo
Valentina Favoni
Sabina Cevoli
Publication date: 20-06-2022
Publisher: Springer International Publishing
Keywords: Migraine
Cluster Headache
Medication Overuse Headache
Erenumab
Galcanezumab
Fremanezumab
Published in: Neurological Sciences / Issue 9/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-022-06199-1

At a glance: The STEP trials

Springer Medicine

The ultimate guide to the anti-CGRP monoclonal antibodies galaxy

Abstract

Background

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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