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CGRP pathway monoclonal antibodies for cluster headache.
Expert Opinion on Biological Therapy ( IF 4.6 ) Pub Date : 2020-04-28 , DOI: 10.1080/14712598.2020.1751114
Calvin Chan 1 , Peter J Goadsby 2
Affiliation  

ABSTRACT

Introduction

The involvement of the calcitonin gene-related peptide (CGRP) pathway in primary headache disorders, especially migraine, had led to recent success in the development of new migraine therapies. The CGRP pathway also plays a role in the pathophysiology of cluster headache, so CGRP pathway monoclonal antibodies have been studied in the prevention of cluster headache attacks.

Areas covered

This review will outline the trials of fremanezumab and galcanezumab, the two CGRP pathway monoclonal antibodies that have undergone trials in cluster headache prevention. This review will highlight key efficacy and safety outcomes from the trials.

Expert opinion

Galcanezumab was shown to be efficacious, reducing the frequency of attacks in episodic cluster headache, while fremanezumab failed its primary endpoint in episodic cluster headache. Both fremanezumab and galcanezumab trials in chronic cluster headache were terminated after futility analysis predicting the failure of both trials to fulfil their primary endpoint. The role of CGRP in cluster headache supports ongoing trials of the remaining CGRP pathway monoclonal antibodies and gepants for preventive and acute treatment.

A broad view would include targeting neuropeptides involved in parasympathetic signaling in cluster headache, such as pituitary adenylate cyclase-activating peptide (PACAP); such targets warrant exploration in the search of new treatments.



中文翻译:

CGRP途径单克隆抗体,用于丛集性头痛。

摘要

介绍

降钙素基因相关肽(CGRP)途径与原发性头痛疾病(尤其是偏头痛)有关,最近在开发新的偏头痛疗法方面取得了成功。CGRP途径在丛集性头痛的病理生理中也起作用,因此已经研究了CGRP途径单克隆抗体在预防丛集性头痛发作中。

覆盖区域

这篇综述将概述fremanezumab和galcanezumab的临床试验,这两种CGRP途径单克隆抗体已在丛集性头痛的预防中进行了试验。这篇综述将重点介绍试验的关键功效和安全性结果。

专家意见

Galcanezumab被证明是有效的,减少了发作性丛集性头痛的发作频率,而fremanezumab未能达到发作性丛集性头痛的主要终点。在无效性分析预测两项试验均无法实现其主要终点后,终止了针对慢性丛集性头痛的fremanezumab和galcanezumab试验。CGRP在丛集性头痛中的作用支持正在进行的针对预防性和急性治疗的剩余CGRP途径单克隆抗体和助流剂的试验。

广泛的观点将包括靶向参与丛集性头痛中副交感神经传递的神经肽,例如垂体腺苷酸环化酶激活肽(PACAP);这些目标值得探索寻找新的治疗方法。

更新日期:2020-04-28
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