Developments in targeting calcitonin gene-related peptide

Area of Science:

• Neurology
• Pharmacology
• Pain Management

Background:

• Calcitonin Gene-Related Peptide (CGRP)-targeted therapy, approved in 2018, has revolutionized migraine treatment.
• This therapy modulates trigeminal nociceptive and inflammatory responses, addressing pain sensitization in migraine pathogenesis.
• CGRP-targeted agents include monoclonal antibodies (mAbs) and gepants.

Purpose of the Study:

• To review the latest developments and evidence for CGRP-targeted therapy in episodic and chronic migraine.
• To discuss emerging evidence on response prediction, specific migraine types (menstrual, vestibular), and related conditions.
• To explore the use of CGRP-targeted therapy beyond migraine, including other chronic pain and psychological comorbidities.

Main Methods:

• Literature review of recent studies on CGRP-targeted therapy.
• Analysis of clinical evidence for efficacy and practical considerations.
• Discussion of expert opinions on current and future applications.

Main Results:

• CGRP-targeted therapy is effective for both episodic and chronic migraine.
• Combination therapy with mAbs and gepants is a viable option for partial responders.
• Evidence is emerging for CGRP-targeted therapy in menstrual migraine, vestibular migraine, and post-traumatic headache.
• The disease-modifying potential of CGRP-targeted therapy is likely, but optimal discontinuation timing is unknown.

Conclusions:

• CGRP-targeted therapy represents a significant advancement in migraine management.
• Its application extends to various headache disorders and potentially other chronic pain conditions.
• Further research is needed to optimize treatment strategies and understand long-term effects.