The ultimate guide to the anti-CGRP monoclonal antibodies galaxy.


Journal

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175

Informations de publication

Date de publication:
Sep 2022
Historique:
received: 02 05 2022
accepted: 01 06 2022
pubmed: 22 6 2022
medline: 20 8 2022
entrez: 21 6 2022
Statut: ppublish

Résumé

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

Sections du résumé

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

Identifiants

pubmed: 35725856
doi: 10.1007/s10072-022-06199-1
pii: 10.1007/s10072-022-06199-1
doi:

Substances chimiques

Antibodies, Monoclonal 0
Calcitonin Gene-Related Peptide JHB2QIZ69Z

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

5673-5685

Informations de copyright

© 2022. Fondazione Società Italiana di Neurologia.

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Auteurs

Davide Mascarella (D)

Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy.

Eleonora Matteo (E)

Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy.

Valentina Favoni (V)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.

Sabina Cevoli (S)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. sabina.cevoli@unibo.it.

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Humans Yoga Low Back Pain Female Male

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