CGRP, or calcitonin gene-related peptide, is a protein that plays a significant role in various bodily functions such as the regulation of blood pressure, pain sensations, and the response to stress.
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In the battle against migraines, medical researchers have been developing new treatments that target a protein called calcitonin gene-related peptide (CGRP). These treatments, known as CGRP antagonists, are making a significant impact on migraine management.
CGRP plays a crucial role in the brain, linking to the feeling of pain and how tissues and blood vessels react. This makes it an essential player in migraine pain.
There are different types of CGRP antagonists, including monoclonal antibodies (mAbs) and small molecule CGRP receptor antagonists, commonly known as gepants.
Monoclonal Antibodies (mAbs)
Migraine treatment options such as Vyepti, Aimovig, and Emgality are CGRP mAbs. These medications block the action of CGRP, preventing migraine pain. Vyepti is delivered as an intravenous (IV) infusion, while Aimovig and Emgality are self-administered injections.
The most common side effects of CGRP mAbs for migraine treatment are injection site reactions, including pain, redness, and swelling. These occur in a significant portion of patients, with up to 45% experiencing them with Ajovy. Other reported side effects include hypersensitivity reactions like rash, itching, and urticaria.
It's important to note that about 50% of patients experience at least one side effect, but these are mostly mild and comparable across different CGRP mAbs. There is some potential for immunogenicity, with anti-drug antibodies detected in approximately 1.6% of patients in long-term studies with Ajovy, though the clinical impact remains unclear.
Rare post-marketing reports mention side effects such as alopecia (hair loss) with Aimovig, though this was not observed in clinical trials. Safety in pregnancy is not well established, with registries monitoring outcomes for those exposed during pregnancy.
Gepants
Unlike some other medications, gepants do not constrict blood vessels but prevent them from dilating. The three gepants available in the United States are ubrogepant (Ubrelvy), rimegepant (Nurtec), and atogepant (Qulipta).
The most common side effects of gepants include fatigue, nausea, dizziness, and dry mouth. These side effects are generally mild and manageable.
By targeting CGRP receptors, gepants block the effect of CGRP and prevent migraine pain. This makes them a safer alternative for people with heart or cardiovascular disease, as they do not cause vasoconstriction, a side effect of some other migraine medications.
In summary, injection site reactions are the most frequent side effect of CGRP mAbs, followed by hypersensitivity issues, with other adverse reactions occurring less commonly. Most side effects are mild, and CGRP mAbs are generally well tolerated in migraine prevention. Gepants, on the other hand, have a different side effect profile, with fatigue, nausea, dizziness, and dry mouth being the most common.
In addition to these treatments, reducing the frequency of migraine attacks may involve lifestyle measures such as regular exercise, avoiding migraine triggers, eating regularly scheduled meals, drinking enough water, quitting certain medications, setting up a regular sleep schedule, and practicing weight management.
As research continues, we can expect to see more developments in the field of CGRP antagonists and their role in migraine treatment.
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