Abstract
Headaches due to migraine are the second leading cause of disability in the world. Migraine can be classified as episodic migraine (EM) and chronic migraine (CM). The course of the disease starts from an aura followed by 4-72 hours of bouts of throbbing, mostly unilateral headache associated with nausea, photo/phonophobia with/without neurological deficit. The pathophysiology of migraine remains debatable and many drugs are used to help control migraine attacks with little or no benefit. However, patient compliance remains a reason for over and underdosing of these medications. The calcitonin gene-related peptide (CGRP), a vasoactive peptide is known to contribute to the disease course. Much work is done on antagonizing the receptor or the molecule itself. For this purpose, genetically engineered monoclonal antibodies are being utilized for long-term reduction in morbidity and prevention of migraine headaches. The four to name are: galcanezumab, fremanezumab, eptinezumab, and erenumab. The purpose of this review is to shed light on the use of these monoclonal antibodies, completed and recruiting trials, and the role of these medications in the prevention of not only EM and CM but also in medication overuse headaches.
Highlights
BackgroundMigraine remains a challenging disease throughout the world affecting around 12% of the population [1]
This study suggested that monthly migraine days (MMDs) of episodic migraine (EM) were reduced to 3.7 days at 225 mg of the drug at 12 weeks and 3.4 days at 675 mg given for the same duration of time, while there was a reduction of MMD by 2.2 days in the placebo arm of the study [23]
This study proved that fremanezumab can be used in the prevention of various migraine attacks [24]
Summary
Migraine remains a challenging disease throughout the world affecting around 12% of the population [1]. To reduce morbidity in patients with migraine, a 12-week, phase 3, double-blind, placebo-controlled, randomized clinical trial was conducted to evaluate the efficacy, safety, and side-effect profile of fremanezumab administered in two subcutaneous doses for the prevention of CM. To assess the effectiveness of the drug to prevent frequency in EM, participants were recruited in two trials PROMISE 1 and 2 These two placebo-controlled, double-blind, phase 3 randomized clinical trials were seen to evaluate the efficacy and safety profile of eptinezumab. The "RELIEF" trial is a double-blind, placebo-controlled, phase-3 randomized clinical trial, currently recruiting participants and is seen to evaluate the efficacy and safety of eptinezumab when administered intravenously during acute migraine attacks versus placebo. Much work is done to prevent the attacks of migraine Another phase-3 double-blind, placebo-controlled, randomized clinical trial was conducted to evaluate the efficacy and safety of erenumab versus placebo. The prevention of this condition is achieved using CGRP monoclonal antibodies and botulinum toxin type A [34]
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