Calcitonin gene related peptide in migraine: current therapeutics, future implications and potential off-target effects.

Migraine is the second largest cause of years lost to disability globally among all diseases, with a worldwide prevalence over 1 billion. Despite the global burden of migraine, few classes of therapeutics have been specifically developed to combat migraine. After 30 years of translational research, calcitonin gene-related peptide (CGRP) inhibitors have emerged as a promising new tool in the prevention of migraine. Like all new therapeutics; however, we have limited real-world experience and CGRP has several known systemic actions that warrant consideration. This article provides a narrative review of the evidence for CGRP antagonists and summarises the known and potential side effects that should be considered.

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Competing interests: MM serves on the advisory board for Allergan, Novartis, Eli Lilly, Autonomic Technologies and TEVA and has received payment for the development of educational presentations from Allergan, electroCore, Eli Lilly, Novartis and TEVA. RJS has been a member of Advisory Boards for Allergan, Novartis, Teva and Eli Lilly and has received Lecture Fees from Allergan, Novartis, Teva and Eli Lilly and Biogen. EJH has served on advisory boards for Sanofi-Genzyme, Novartis, Teva, Eli Lilly, Allergan, been involved in clinical trials sponsored by Novartis and Teva, and has received payment for educational presentations from Allergan, Teva, Eli Lilly and Novartis. S-JW has served on the advisory boards of Eli Lilly, Daiichi-Sankyo and Taiwan Norvatis. He has received honoraria as a moderator from Allergan, Pfizer, Eli Lilly, Bayer, and Eisai. He has received research grants from the Taiwan Minister of Technology and Science, Brain Research Center, National Yang-Ming University from The Featured Areas Research Center Programme within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan, Taipei Veterans General Hospital, and Taiwan Headache Society. LB serves on the advisory board for Allergan, Novartis, Eli Lilly and Teva, has been involved in clinical trials sponsored by Novartis and has received payment for educational presentations from Allergan, Teva and Novartis. JR and MK report no potential conflict of interest. Figure created with biorender.com.