Role of calcitonin gene-related peptide (CGRP) receptor antagonist in acute and preventive treatment of migraine
DOI:
https://doi.org/10.56782/pps.206Keywords:
CGRP, gepants, headache, rimegepant, ubrogepant, migraineAbstract
Migraine is the most common neurological disease in the world. It is characterized by recurrent attacks of severe headaches of a one-sided, throbbing nature, often accompanied by sensory and motor disturbances and generally associated with nausea and increased sensitivity to light and sound. Migraine treatment can be divided into emergency treatment and preventive treatment, which aims to reduce the overall frequency and severity of attacks. In the first case, nonsteroidal anti-inflammatory drugs (NSAIDs) can be used, but in some patients they do not have the desired effect. The gold standard in the fight against migraine pain are triptans (selective serotonin 5-HT1 receptor agonists), although they too are not effective in all patients. Current understanding suggests that calcitonin gene-related peptide (CGRP) plays a significant role in the pathophysiology of migraines. Evidence supporting this includes increased CGRP levels during migraine attacks, causing inflammation and activation of other pathophysiological processes responsible for pain. The hope for patients are CGRP receptor antagonists, which greatly expand therapeutic options.
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References
Li, D.; Abreu, J.; Tepper, S.J. A Brief Review of Gepants. Curr. Pain Headache Rep. 2023, 27, 479–488. DOI: 10.1007/S11916-023-01142-1/METRICS. DOI: https://doi.org/10.1007/s11916-023-01142-1
Robbins, M.S. Diagnosis and Management of Headache: A Review. JAMA 2021, 325, 1874–1885. DOI: 10.1001/jama.2021.1640. DOI: https://doi.org/10.1001/jama.2021.1640
Richer, L.; Billinghurst, L.; Linsdell, M.A.; Russell, K.; Vandermeer, B.; Crumley, E.T.; et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database of Systematic Reviews 2016, 4, Art. No.: CD005220. DOI: 10.1002/14651858.CD005220.pub2. DOI: https://doi.org/10.1002/14651858.CD005220.pub2
Kowacs, P.A.; Sampaio Rocha-Filho, P.A.; Peres, M.F.P.; Edvinsson, L. The history and rationale of the development of new drugs for migraine treatment. Arq. Neuropsiquiatr. 2023, 81, 1084–1097. DOI: 10.1055/s-0043-1777723. DOI: https://doi.org/10.1055/s-0043-1777723
Olesen, J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018, 38, 1–211. DOI: 10.1177/0333102417738202. DOI: https://doi.org/10.1177/0333102417738202
Messina, R.; Huessler, E.M.; Puledda, F.; Haghdoost, F.; Lebedeva, E.R.; Diener, H.C. Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: A systematic review and network meta-analysis. Cephalalgia 2023, 43(3), Art. No: 3331024231152169. DOI: 10.1177/03331024231152169. DOI: https://doi.org/10.1177/03331024231152169
Seong, J.W.; Kim, Y.; Kwon, D.R.; Yang, C.-J.; Özçakar, L. Effectiveness of Novel Sympathetic Nerve Entrapment Point Injections for Chronic Migraine: A Pilot Study. Life (Basel) 2023, 14, Art. No: 57. DOI: 10.3390/life14010057. DOI: https://doi.org/10.3390/life14010057
Yang, Y.; Chen, M.; Sun, Y.; Gao, B.; Chen, Z.; Wang, Z. Safety and Efficacy of Ubrogepant for the Acute Treatment of Episodic Migraine: A Meta-Analysis of Randomized Clinical Trials. CNS Drugs 2020, 34, 463–471. DOI: 10.1007/s40263-020-00715-7. DOI: https://doi.org/10.1007/s40263-020-00715-7
Ogunlaja, O.I.; Goadsby, P.J. Headache: Treatment update. E. Neurological Sci. 2022, 29, Art. No: 100420. DOI: 10.1016/J.ENSCI.2022.100420. DOI: https://doi.org/10.1016/j.ensci.2022.100420
Dodick, D.W.; Lipton, R.B.; Ailani, J.; Lu, K.; Finnegan, M.; Trugman, J.M.; et al. Ubrogepant for the Treatment of Migraine. N. Engl. J. Med. 2019, 381, 2230–2241. DOI: 10.1056/NEJMOA1813049. DOI: https://doi.org/10.1056/NEJMoa1813049
Chiang, C.C.; Fang, X.; Horvath, Z.; Cadiou, F.; Urani, A.; Poh, W.; et al. Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users’ Self-Reported Records From a Smartphone Application. Neurology 2023, 101, E2560–E2570. DOI: 10.1212/WNL.0000000000207964. DOI: https://doi.org/10.1212/WNL.0000000000207964
Singh, R.B.H.; VanderPluym, J.H.; Morrow, A.S.; Urtecho, M.; Nayfeh, T.; et al. Acute Treatments for Episodic Migraine. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 (Comparative Effectiveness Review, No. 239.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK566246/
Ashina, M.; Hansen, J.M.; Do, T.P.; Melo-Carrillo, A.; Burstein, R.; Moskowitz, M.A. Migraine and the trigeminovascular system—40 years and counting. Lancet Neurol. 2019, 18, 795–804. DOI: 10.1016/S1474-4422(19)30185-1. DOI: https://doi.org/10.1016/S1474-4422(19)30185-1
Puledda, F.; Martins Silva, E.; Suwanlaong, K.; Goadsby, P.J. Migraine: from pathophysiology to treatment. J. Neurol. 1234, 270, 3654–3666. DOI: 10.1007/s00415-023-11706-1. DOI: https://doi.org/10.1007/s00415-023-11706-1
Schoonman, G.G.; Van Der Grond, J.; Kortmann, C.; Van Der Geest, R.J.; Terwindt, G.M.; Ferrari, M.D. Migraine headache is not associated with cerebral or meningeal vasodilatation - A 3T magnetic resonance angiography study. Brain 2008, 131, 2192–2200. DOI: 10.1093/BRAIN/AWN094. DOI: https://doi.org/10.1093/brain/awn094
Altamura, C.; Brunelli, N.; Marcosano, M.; Fofi, L.; Vernieri, F. Gepants — a long way to cure: a narrative review. Neurol. Sci. 2022, 43(9), 5697-570. DOI: 10.1007/s10072-022-06184-8. DOI: https://doi.org/10.1007/s10072-022-06184-8
Curto, M.; Capi, M.; Cipolla, F.; Cisale, G.Y.; Martelletti, P.; Lionetto, L. Ubrogepant for the treatment of migraine. Expert Opin. Pharmacother. 2020, 21, 755–759. DOI: 10.1080/14656566.2020.1721462. DOI: https://doi.org/10.1080/14656566.2020.1721462
Wei, S.; Lv, H.; Yang, D.; Zhang, L.; Li, X.; Ning, Y.; et al. Drug-related side effects and adverse reactions in the treatment of migraine: a bibliometric and visual analysis. Front. Neurol. 2024, 15, Art. No: 1342111. DOI: 10.3389/fneur.2024.1342111.
Kopka, M. Gepanty drugiej generacji w leczeniu migreny-analiza wyników randomizowanych badań kontrolowanych [Second-generation gepants in the treatment of migraine-a review of the findings of randomised controlled trials] Aktualn. Neurol. 2022, 22 (4), 180–184. DOI: . DOI: https://doi.org/10.15557/AN.2022.0022
Tepper, S.J. History and Review of anti-Calcitonin Gene-Related Peptide (CGRP) Therapies: From Translational Research to Treatment. Headache 2018, 58, 238–275. DOI: 10.1111/head.13379. DOI: https://doi.org/10.1111/head.13379
Vo, P.; Fang, J.; Bilitou, A.; Laflamme, A.K.; Gupta, S. Patients’ perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom. J. Headache Pain 2018, 19, Art. No: 82. DOI: 10.1186/S10194-018-0907-6. DOI: https://doi.org/10.1186/s10194-018-0907-6
Bigal, M.; Borucho, S.; Serrano, D.; Lipton, R. The acute treatment of episodic and chronic migraine in the USA. Cephalalgia 2009, 29, 891–897. DOI: 10.1111/J.1468-2982.2008.01819.X. DOI: https://doi.org/10.1111/j.1468-2982.2008.01819.x
Bonafede, M.; Sapra, S.; Shah, N.; Tepper, S.; Cappell, K.; Desai, P. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States. Headache 2018, 58, 700–714. DOI: 10.1111/HEAD.13275. DOI: https://doi.org/10.1111/head.13275
Leonardi, M.; Raggi, A.; Bussone, G.; D’Amico, D. Health-related quality of life, disability and severity of disease in patients with migraine attending to a specialty headache center. Headache 2010, 50, 1576–1586. DOI: 10.1111/J.1526-4610.2010.01770.X. DOI: https://doi.org/10.1111/j.1526-4610.2010.01770.x
Hagan, J.C. Systematic Review and Meta-analysis of Acute Treatments for Episodic Migraine in Adults. JAMA 2021, 326(16), 1636. DOI: 10.1001/jama.2021.14060. DOI: https://doi.org/10.1001/jama.2021.14060
Chiang, C.C.; Schwedt, T.J. Calcitonin gene-related peptide (CGRP)-targeted therapies as preventive and acute treatments for migraine—The monoclonal antibodies and gepants. Prog. Brain Res. 2020, 255, 143–170. DOI: 10.1016/bs.pbr.2020.06.019. DOI: https://doi.org/10.1016/bs.pbr.2020.06.019
MacDonald, D.I.; Jayabalan, M.; Seaman, J.; Nickolls, A.; Chesler, A. Pain persists in mice lacking both Substance P and CGRPα signaling. BioRxiv 2023.11.15.567208; doi: https://doi.org/10.1101/2023.11.15.567208 DOI: https://doi.org/10.1101/2023.11.15.567208
Wei, S.; Lv, H.; Yang, D.; Zhang, L.; Li, X.; Ning, Y.; et al. Drug-related side effects and adverse reactions in the treatment of migraine: a bibliometric and visual analysis. Front. Neurol. 2024, 15, Art. No: 1342111. DOI: 10.3389/FNEUR.2024.1342111. DOI: https://doi.org/10.3389/fneur.2024.1342111
Linde, M.; Gustavsson, A.; Stovner, L.J.; Steiner, T.J.; Barré, J.; Katsarava, Z.; et al. The cost of headache disorders in Europe: The Eurolight project. Eur. J. Neurol. 2012, 19, 703–711. DOI: 10.1111/J.1468-1331.2011.03612.X. DOI: https://doi.org/10.1111/j.1468-1331.2011.03612.x
Moreno-Ajona, D.; Chan, C.; Villar-Martínez, M.D.; Goadsby, P.J. Targeting CGRP and 5-HT1F Receptors for the Acute Therapy of Migraine: A Literature Review. Headache 2019, 59, 3–19. DOI: 10.1111/HEAD.13582. DOI: https://doi.org/10.1111/head.13582
Buse, D.C.; Manack, A.; Serrano, D.; Turkel, C.; Lipton, R.B. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J. Neurol. Neurosurg. Psychiatry 2010, 81, 428–432. DOI: 10.1136/JNNP.2009.192492. DOI: https://doi.org/10.1136/jnnp.2009.192492
Peroutka, S.J. Neurogenic inflammation and migrane: Implications for therapeutics. Mol. Interv. 2005, 5, 304–311. DOI: 10.1124/MI.5.5.10. DOI: https://doi.org/10.1124/mi.5.5.10
Goadsby, P.J. The pharmacology of headache. Prog. Neurobiol. 2000, 62, 509–525. DOI: 10.1016/S0301-0082(00)00010-1. DOI: https://doi.org/10.1016/S0301-0082(00)00010-1
Blair, H.A. Rimegepant: A Review in the Acute Treatment and Preventive Treatment of Migraine. CNS Drugs 2023, 37, 255–265. DOI: 10.1007/s40263-023-00988-8. DOI: https://doi.org/10.1007/s40263-023-00988-8
González-Hernández, A.; Marichal-Cancino, B.A.; MaassenVanDenBrink, A.; Villalón, C.M. Side effects associated with current and prospective antimigraine pharmacotherapies. Expert Opin. Drug Metab. Toxicol. 2018, 14, 25–41. DOI: 10.1080/17425255.2018.1416097. DOI: https://doi.org/10.1080/17425255.2018.1416097
Vanderpluym, J.H.; Halker Singh, R.B.; Urtecho, M.; Morrow, A.S.; Nayfeh, T.; Torres Roldan, V.D.; et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Rweview and Meta-analysis. JAMA 2021, 325, 2357–2369. DOI: 10.1001/JAMA.2021.7939. DOI: https://doi.org/10.1001/jama.2021.7939
Burch, R.; Rayhill, M. Acute Treatment for Migraine: Contemporary Treatments and Future Directions. JAMA 2021, 325, 2346–2347. DOI: 10.1001/jama.2021.7275. DOI: https://doi.org/10.1001/jama.2021.7275
de Vries, T.; Villalón, C.M.; MaassenVanDenBrink, A. Pharmacological treatment of migraine: CGRP and 5-HT beyond the triptans. Pharmacol. Ther. 2020, 211, Art. No: 107528. DOI: 10.1016/j.pharmthera.2020.107528. DOI: https://doi.org/10.1016/j.pharmthera.2020.107528
Schoenen, J.; Manise, M.; Nonis, R.; Gérard, P.; Timmermans, G. Monoclonal antibodies blocking CGRP transmission: An update on their added value in migraine prevention. Rev. Neurol. (Paris) 2020, 176, 788–803. DOI: 10.1016/j.neurol.2020.04.027. DOI: https://doi.org/10.1016/j.neurol.2020.04.027
Moisset, X.; Demarquay, G.; Ducros, A. Systematic Review and Meta-analysis of Acute Treatments for Episodic Migraine in Adults. JAMA 2021, 326, 1636–1637. DOI: 10.1001/jama.2021.14063. DOI: https://doi.org/10.1001/jama.2021.14063
Yang, C.P.; Liang, C.S.; Chang, C.M.; Yang, C.C.; Shih, P.H.; Yau, Y.C.; et al. Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine A Systematic Review and Meta-analysis. JAMA Netw Open 2021, 4(10), Art. No: e2128544. DOI: 10.1001/jamanetworkopen.2021.28544. DOI: https://doi.org/10.1001/jamanetworkopen.2021.28544
Moreno-Ajona, D.; Pérez-Rodríguez, A.; Goadsby, P.J. Gepants, calcitonin-gene-related peptide receptor antagonists: what could be their role in migraine treatment? Curr. Opin. Neurol. 2020, 33, 309–315. DOI: 10.1097/WCO.0000000000000806. DOI: https://doi.org/10.1097/WCO.0000000000000806
Ailani, J.; Lipton, R.B.; Goadsby, P.J. et al.; ADVANCE Study Group: Atogepant for the preventive treatment of migraine. N. Engl. J. Med. 2021, 385(8), 695–706. DOI: 10.1056/NEJMoa2035908 DOI: https://doi.org/10.1056/NEJMoa2035908
Croop, R.; Goadsby, P.J.; Stock, D.A. et al.: Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. Lancet 2019, 394 (10200), 737–745. doi: 10.1016/S0140-6736(19)31606-X DOI: https://doi.org/10.1016/S0140-6736(19)31606-X
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Copyright (c) 2024 Michał Dacka, Mateusz Sobczyk , Paulina Dąbrowska , Kamila Giżewska , Michał Żuber
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