Monoclonal antibody erenumab for migraine prevention: a review of new data

Abstract

Monoclonal antibodies (mAT) to calcitonin-gene-related peptide (CGRP) have become the fi rst class of preventive medications specifically designed to treat migraines. The article examines the mechanism of action of mAT from the standpoint of a modern view of the pathophysiology of migraine, discusses the issues of immunogenicity and drug interaction. The review describes in detail the monoclonal antibody erenumab, which became available in Russia from February 2020. The action of erenumab is associated with blocking the CGRP receptor, since it is the only one of the existing mAT that competes with the CGRP molecule for binding to the receptor. This review summarizes the pharmacological characteristics of erenumab, presents in detail the results of clinical trials with an emphasis on the publications of the last year. The article also presents the role of this method of treatment in real clinical practice: the eff ectiveness and safety of erenumab in various forms of migraine are described in detail, the possibility of transition (“reverse transformation”) from chronic migraine to episodic form on erenumab therapy is shown, impressive results of treatment of intractable cases in resistant and refractory migraines are presented. Erenumab is the only one of the mAT drugs for which the results of five-year clinical observations have been published, which have proved the sustained effectiveness and safety in long-term use, as well as the economic feasibility of using this therapeutic approach.