Inflammatory complications of CGRP monoclonal antibodies: a case series.

Antibodies, Monoclonal / adverse effects Calcitonin Calcitonin Gene-Related Peptide Central Nervous System Humans Migraine Disorders / drug therapy
Autoimmune diseases CGRP CGRP receptor antagonists Drug-related side effects and adverse reactions Migraine Monoclonal antibodies

Journal

The journal of headache and pain
ISSN: 1129-2377
Titre abrégé: J Headache Pain
Pays: England
ID NLM: 100940562

Informations de publication

Date de publication:
09 Oct 2021
Historique:
received: 10 08 2021
accepted: 16 09 2021
entrez: 9 10 2021
pubmed: 10 10 2021
medline: 13 10 2021
Statut: epublish

Résumé

Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.

Sections du résumé

BACKGROUND BACKGROUND
Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response.
CASES METHODS
We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy.
CONCLUSION CONCLUSIONS
This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.

Identifiants

DOI: 10.1186/s10194-021-01330-7 PMID: 34625019 PMC: PMC8501661
pubmed: 34625019
doi: 10.1186/s10194-021-01330-7
pii: 10.1186/s10194-021-01330-7
pmc: PMC8501661
doi:

Substances chimiques

Antibodies, Monoclonal 0
Calcitonin 9007-12-9
Calcitonin Gene-Related Peptide JHB2QIZ69Z

Types de publication

Case Reports Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

121

Informations de copyright

© 2021. The Author(s).

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Auteurs

Jason C Ray (JC)

Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia. J.Ray@alfred.org.au.
Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Germany. J.Ray@alfred.org.au.
Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia. J.Ray@alfred.org.au.
ORCID: 0000-0003-4833-5507

Penelope Allen (P)

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Australia.

Ann Bacsi (A)

Integrated Specialist Medical Care, Sydney, Australia.

Julian J Bosco (JJ)

Department of Allergy, asthma and clinical immunology, Alfred Hospital, Commercial Road 3004, Melbourne, Australia.
Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.

Luke Chen (L)

Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.
Otoneurology Diagnostic Unit, Alfred Hospital, Commercial Rd 3004, Melbourne, VIC, Australia.

Michael Eller (M)

Department of Neurology, Monash Medical Centre, Vic, Melbourne, Australia.
School of Clinical Sciences, Monash University, Vic, Melbourne, Australia.

Hock Kua (H)

Department of Pathology, Monash Medical Centre, Vic, Melbourne, Australia.

Lyndell L Lim (LL)

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Australia.

Manjit S Matharu (MS)

University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, University College London, Gower Street WC1E 6BT, London, UK.

Mastura Monif (M)

Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.
Department of Neurology, Royal Melbourne Hospital, Vic, Parkville, 3050, Australia.
MS and Neuroimmunology Department, Alfred Hospital, Vic, Melbourne, 3004, Australia.

Martin Ruttledge (M)

Consultant Neurologist & Headache Clinical Lead, Beaumont Hospital, Beaumont Road, Dublin, Ireland.

Richard J Stark (RJ)

Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia.
Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.

Elspeth J Hutton (EJ)

Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia.
Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.

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Classifications MeSH

questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Anticorps monoclonaux › Inflammatory complications of CGRP monoclonal...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines de tissu nerveux › Neuropeptides › Calcitonine › Inflammatory complications of CGRP monoclonal...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines de tissu nerveux › Neuropeptides › Peptide relié au gène de la calcitonine › Inflammatory complications of CGRP monoclonal...
questionsmedicales.fr › Système nerveux › Système nerveux central › Inflammatory complications of CGRP monoclonal...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Inflammatory complications of CGRP monoclonal...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Encéphalopathies › Céphalées › Céphalées primitives › Migraines › Inflammatory complications of CGRP monoclonal...