Anti-CGRP basierte Migränemedikamente – eine Übersicht der Studienlage

Zusammenfassung

Seit Anfang der 1990er Jahre ist bekannt, dass das Neuropeptid Calcitonin Gene-Related Peptid (CGRP) eine Schlüsselrolle in der Pathophysiologie der Migräne spielt. Mit dieser Entdeckung ergaben sich in der Migränetherapie neue Angriffspunkte für Medikamente, die in den letzten Jahren unser therapeutisches Arsenal revolutioniert haben. Während bisherige Prophylaktika relativ unspezifisch wirkten und mit oft nicht tolerablen Nebenwirkungen einhergingen, entstanden mit CGRP als Zielstruktur in der Migräneprophylaxe gut verträgliche und hocheffektive neue Therapieoptionen. Die zwei Hauptklassen der CGRP-spezifischen Migränetherapie sind monoklonale Antikörper, die CGRP oder den CGRP-Rezeptor binden und Gepante, CGRP-Rezeptor Antagonisten, die aufgrund ihrer molekularen Eigenschaften die intrazelluläre Signaltransmission blockieren. In großen Zulassungsstudien konnte die Sicherheit, Verträglichkeit und Wirksamkeit von monoklonalen CGRP-Antikörpern in der prophylaktischen Therapie der episodischen und chronischen Migräne nachgewiesen werden. Gleiches gilt für den Einsatz verschiedener Gepante, die sich in der Akuttherapie als Alternative zu Triptanen und bei kontinuierlicher Einnahme als Prophylaktika in klinischen Studien als effektiv und sicher herausstellten. In dieser Übersichtsarbeit möchten wir den aktuellen Stand der Forschung zur CGRP-spezifischen Migränetherapie und Erkenntnisse aus ersten Anwendungsdaten darlegen.

Abstract

In the early 1990s, the neuropeptide calcitonin gene-related peptide (CGRP) was identified as a key messenger in the pathophysiology of migraine and emerged as a treatment target, fundamentally transforming our approach to migraine therapy. While previous prophylactic drugs were non-specific and often caused intolerable side effects, the discovery of CGRP marked the advent of a new era in migraine treatment. The two main classes of CGRP-specific migraine treatments are monoclonal antibodies that bind to CGRP or the CGRP receptor, and CGRP receptor antagonists, the so-called gepants. Extensive clinical trials have conclusively demonstrated the safety, tolerability, and efficacy of monoclonal CGRP(-receptor) antibodies in the prophylactic treatment of both episodic and chronic migraine. The same positive results apply to the use of various gepants. They have proven to be not only an effective alternative to triptans in acute migraine therapy but also promising options for continuous use as prophylactic treatments. In this review, we aim to present the current state of research on CGRP-specific migraine therapy and insights in real-world data from the first years after their launch in clinical practice.

Schlüsselwörter

Migräne - CGRP - CGRP-Antikörper - Gepante

Keywords

Migraine - CGRP - CGRP antibody - gepants

Publication History

Received: 04 September 2023

Accepted after revision: 19 February 2024

Article published online:
28 March 2024

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