Four antibodies targeting the CGRP paths exist: Erenumab and the Galcanese (which received the European MA in 2018), the framanese (2019) et L’EPTINEMAB (2021). They are indicated in prophylaxis for patients with 4 days or more of migraine headaches per month. The first three are administered as subcutaneous and the fourth intravenously.
Several randomized double -blind trials against placebo have shown their effectiveness in migraine prophylaxis in fundamental treatment, whether episodic (half of the patients have a reduction of at least 50 % of the monthly number of migraine days. In addition, the trials concerning Patients with migraines refractory to 2 to 4 conventional treatments have also shown an efficiency (on average, 2 to 4 days of less migraine per month compared to placebo).
Real life studies have shown even better results: Higher reductions in the monthly number of migraine days, higher proportion of patients with a response rate ≥ 50 % (up to three quarters).
The period of response to these treatments is fast in some patients from the first month, but “late” responders (between three and six months) have notably been detected in real life studies.
Finally, tolerance is generally good: meta-analyzes have found that the frequency of side effects is lower than with conventional background treatments such as valproate, amitriptyline and topiramate. They include constipation, allergic reactions, a possible elevation of the PA; IS to monitor (still anecdotally reported) include alopecia, Raynaud’s phenomenon, erectile dysfunction or alteration of healing. They are contraindicated in case of cardiovascular or pregnancy pathology.
If the studies directly comparing these monoclonal antibodies with conventional treatments are rare, all the data available so far show a real added value which resides in their High efficiency – at least comparable to that of conventional treatments – combined with a good tolerance profile which promotes observance.
