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CGRP pathway monoclonal antibodies for cluster headache.
Calvin Chan1, Peter J Goadsby2
1Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King's College London.
Expert Opinion on Biological Therapy
|April 4, 2020
Summary
Calcitonin gene-related peptide (CGRP) monoclonal antibodies showed mixed results for cluster headache prevention. Galcanezumab was effective in episodic cases, but fremanezumab and both in chronic cases failed to meet primary endpoints.
Area of Science:
- Neurology
- Pharmacology
Background:
- The calcitonin gene-related peptide (CGRP) pathway is implicated in primary headache disorders, including migraine and cluster headache.
- This has prompted investigation into CGRP pathway-targeting therapies for cluster headache prevention.
Purpose of the Study:
- To review clinical trials of CGRP pathway monoclonal antibodies (fremanezumab and galcanezumab) for cluster headache prevention.
- To highlight efficacy and safety findings from these trials.
Main Methods:
- Review of clinical trial data for fremanezumab and galcanezumab in episodic and chronic cluster headache.
- Analysis of primary efficacy endpoints and safety outcomes.
Main Results:
- Galcanezumab demonstrated efficacy in reducing attack frequency in episodic cluster headache.
- Fremanezumab did not meet its primary endpoint in episodic cluster headache.
- Trials for both agents in chronic cluster headache were terminated due to futility.
Conclusions:
- CGRP pathway monoclonal antibodies show potential but with variable efficacy in cluster headache subtypes.
- Further research into CGRP and other neuropeptides like PACAP is warranted for novel cluster headache treatments.
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