PDF(Pubmed)
Abstract：
BACKGROUND: Chronic migraine is a highly debilitating condition that is often difficult to manage, particularly in the presence of medication overuse headache. Drugs targeting the calcitonin gene-related peptide (CGRP), or its receptor have shown promising results in treating this disorder.
METHODS: We searched Pubmed and Embase to identify randomized clinical trials and real-world studies reporting on the use of medication targeting the calcitonin gene-related peptide in patients with chronic migraine.
RESULTS: A total of 270 records were identified. Nineteen studies qualified for the qualitative analysis. Most studies reported on monoclonal antibodies targeting CGRP (anti-CGRP mAbs), that overall prove to be effective in decreasing monthly migraine days by half in about 27.6-61.4% of the patients. Conversion from chronic to episodic migraine was seen in 40.88% of the cases, and 29-88% of the patients stopped medication overuse. Obesity seems to be the main negative predictor of response to anti-CGRP mAbs. There is no evidence to suggest the superiority of one anti-CGRP mAb. Despite the lack of strong evidence, the combination of anti-CGRP medication with onabotulinumtoxinA in chronic migraine is likely to bring benefits for resistant cases. Atogepant is the first gepant to demonstrate a significant decrease in monthly migraine days compared to placebo in a recent trial. Further, anti-CGRP mAb and gepants have a good safety profile.
CONCLUSIONS: There is strong evidence from randomized trials and real-world data to suggest that drugs targeting CGRP are a safe and effective treatment for chronic migraine.
METHODS: We searched Pubmed and Embase to identify randomized clinical trials and real-world studies reporting on the use of medication targeting the calcitonin gene-related peptide in patients with chronic migraine.
RESULTS: A total of 270 records were identified. Nineteen studies qualified for the qualitative analysis. Most studies reported on monoclonal antibodies targeting CGRP (anti-CGRP mAbs), that overall prove to be effective in decreasing monthly migraine days by half in about 27.6-61.4% of the patients. Conversion from chronic to episodic migraine was seen in 40.88% of the cases, and 29-88% of the patients stopped medication overuse. Obesity seems to be the main negative predictor of response to anti-CGRP mAbs. There is no evidence to suggest the superiority of one anti-CGRP mAb. Despite the lack of strong evidence, the combination of anti-CGRP medication with onabotulinumtoxinA in chronic migraine is likely to bring benefits for resistant cases. Atogepant is the first gepant to demonstrate a significant decrease in monthly migraine days compared to placebo in a recent trial. Further, anti-CGRP mAb and gepants have a good safety profile.
CONCLUSIONS: There is strong evidence from randomized trials and real-world data to suggest that drugs targeting CGRP are a safe and effective treatment for chronic migraine.
摘要：
背景：慢性偏头痛是一种高度衰弱的疾病，通常难以控制，特别是在药物过度使用头痛的情况下。靶向降钙素基因相关肽（CGRP）的药物，或其受体在治疗这种疾病方面显示出有希望的结果。
方法：我们搜索了Pubmed和Embase，以确定关于慢性偏头痛患者使用针对降钙素基因相关肽的药物的随机临床试验和真实世界研究。
结果：共确定270条记录。19项研究符合定性分析条件。大多数研究报道了靶向CGRP（抗CGRPmAb）的单克隆抗体，总的来说，在约27.6-61.4%的患者中，这证明可以有效地将每月偏头痛天数减少一半。40.88%的病例从慢性偏头痛转变为发作性偏头痛，29-88%的患者停止了药物过度使用。肥胖似乎是对抗CGRPmAb反应的主要阴性预测因子。没有证据表明一种抗CGRP单克隆抗体的优越性。尽管缺乏强有力的证据,在慢性偏头痛中,抗CGRP药物与单乳杆菌毒素A联合治疗可能对耐药病例带来益处.在最近的试验中，与安慰剂相比，Atogepant是第一个证明每月偏头痛天数显着减少的gepant。Further,抗CGRPmAb和gepants具有良好的安全性。
结论：来自随机试验和现实世界数据的有力证据表明，针对CGRP的药物是治疗慢性偏头痛的安全有效的方法。
方法：我们搜索了Pubmed和Embase，以确定关于慢性偏头痛患者使用针对降钙素基因相关肽的药物的随机临床试验和真实世界研究。
结果：共确定270条记录。19项研究符合定性分析条件。大多数研究报道了靶向CGRP（抗CGRPmAb）的单克隆抗体，总的来说，在约27.6-61.4%的患者中，这证明可以有效地将每月偏头痛天数减少一半。40.88%的病例从慢性偏头痛转变为发作性偏头痛，29-88%的患者停止了药物过度使用。肥胖似乎是对抗CGRPmAb反应的主要阴性预测因子。没有证据表明一种抗CGRP单克隆抗体的优越性。尽管缺乏强有力的证据,在慢性偏头痛中,抗CGRP药物与单乳杆菌毒素A联合治疗可能对耐药病例带来益处.在最近的试验中，与安慰剂相比，Atogepant是第一个证明每月偏头痛天数显着减少的gepant。Further,抗CGRPmAb和gepants具有良好的安全性。
结论：来自随机试验和现实世界数据的有力证据表明，针对CGRP的药物是治疗慢性偏头痛的安全有效的方法。
