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J Pain Res. 2017 Dec 8;10:2751-2760. doi: 10.2147/JPR.S128143. eCollection 2017.

Calcitonin gene-related peptide receptor as a novel target for the management of people with episodic migraine: current evidence and safety profile of erenumab.

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1
Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy.
2
Department of Medical, Oral and Biotechnological Sciences, Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
3
Department of Medicine and Science of Aging, Medical Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy.
4
Department of Clinical and Molecular Medicine, Regional Referral Headache Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Contributed equally

Abstract

Migraine is a highly disabling neurological condition, and preventative treatment still remains problematic, due to aspecificity of the majority of the currently available prophylactic drugs. Calcitonin-gene-related peptide (CGRP) plays a crucial role in migraine pathophysiology; agents aimed at blocking its activity have, therefore, been developed in recent years, among which are monoclonal antibodies (mAbs) against CGRP, to prevent migraine. Erenumab is the only mAb that targets the CGRP receptor instead of the ligand, with high specificity and affinity of binding. This review will report on the most recent data on erenumab characteristics and on the results of clinical trials on its employment in the prevention of episodic migraine (4-14 monthly migraine days): one Phase II and two Phase III trials (completed) and one Phase III trial (ongoing). Monthly subcutaneous administration (70 mg or 140 mg) of erenumab vs placebo for 3-6 months showed significantly higher efficacy in reducing the mean monthly number of migraine days and the use of migraine-specific medication, and in decreasing physical impairment and impact of migraine on everyday activities (P<0.001). A favorable safety profile was demonstrated by the lack of significant differences in the occurrence of adverse events in erenumab-treated vs placebo-treated patients. Global results so far obtained point to erenumab as a new promising candidate for the preventative treatment of episodic migraine. Licence applications for erenumab were recently submitted to the Food and Drug Administration in the USA and European Medicines Agency in Europe (May/June 2017).

KEYWORDS:

CGRP; CGRP receptor; episodic migraine; erenumab

Conflict of interest statement

Disclosure In the past 3 years, MAG received funding from Epitech Group, Helsinn Healthcare, and IBSA Institute Biochimique for research unrelated to the topic of the present paper, and honoraria from Helsinn Healthcare, IBSA Institute Biochimique, and royalties from IASP Press. GA received honoraria from Epitech Group and Helsinn Healthcare. PM was in the Advisory Board of Teva, Allergan, Amgen, Novartis, Electrocore. He received Educational Grants from Allergan, ACRAF, and Pfizer; royalties from Springer; research grants from Elytra Pharma and Sanofi; travel reimbursements from EFIC, EHF, and SpringerNature, and an editorial grant from SpringerNature. RC and FC report no conflicts of interest in this work.

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