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Calcitonin gene‐related peptide‐targeting therapies are a first‐line option for the prevention of migraine: An American Headache Society position statement update.

Authors :
Charles, Andrew C.
Digre, Kathleen B.
Goadsby, Peter J.
Robbins, Matthew S.
Hershey, Andrew
Schwedt, Todd J.
Ailani, Jessica
Tepper, Stewart J.
Halker Singh, Rashmi B.
Harriott, Andrea M.
Lay, Christine
Nahas, Stephanie J.
Powers, Scott W.
Rosen, Noah
Starling, Amaal J.
Wells, Rebecca
Source :
Headache: The Journal of Head & Face Pain. Apr2024, Vol. 64 Issue 4, p333-341. 9p.
Publication Year :
2024

Abstract

Objective: To provide a position statement update from The American Headache Society specifically regarding therapies targeting calcitonin gene‐related peptide (CGRP) for the prevention of migraine. Background: All migraine preventive therapies previously considered to be first‐line treatments were developed for other indications and adopted later for migraine. Adherence to these therapies is often poor due to issues with efficacy and tolerability. Multiple new migraine‐specific therapies have been developed based on a broad foundation of pre‐clinical and clinical evidence showing that CGRP plays a key role in the pathogenesis of migraine. These CGRP‐targeting therapies have had a transformational impact on the management of migraine but are still not widely considered to be first‐line approaches. Methods: Evidence regarding migraine preventive therapies including primary and secondary endpoints from randomized placebo‐controlled clinical trials, post hoc analyses and open‐label extensions of these trials, and prospective and retrospective observational studies were collected from a variety of sources including PubMed, Google Scholar, and ClinicalTrials.gov. The results and conclusions based upon these results were reviewed and discussed by the Board of Directors of The American Headache Society to confirm consistency with clinical experience and to achieve consensus. Results: The evidence for the efficacy, tolerability, and safety of CGRP‐targeting migraine preventive therapies (the monoclonal antibodies: erenumab, fremanezumab, galcanezumab, and eptinezumab, and the gepants: rimegepant and atogepant) is substantial, and vastly exceeds that for any other preventive treatment approach. The evidence remains consistent across different individual CGRP‐targeting treatments and is corroborated by extensive "real‐world" clinical experience. The data indicates that the efficacy and tolerability of CGRP‐targeting therapies are equal to or greater than those of previous first‐line therapies and that serious adverse events associated with CGRP‐targeting therapies are rare. Conclusion: The CGRP‐targeting therapies should be considered as a first‐line approach for migraine prevention along with previous first‐line treatments without a requirement for prior failure of other classes of migraine preventive treatment. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00178748
Volume :
64
Issue :
4
Database :
Academic Search Index
Journal :
Headache: The Journal of Head & Face Pain
Publication Type :
Academic Journal
Accession number :
176763784
Full Text :
https://doi.org/10.1111/head.14692