Expert review of neurotherapeutics
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Introduction: This paper reviews placebo-controlled randomized double-blind studies with erenumab for the prevention of migraine. Erenumab is a fully human monoclonal antibody (mAb), which specifically blocks the calcitonin gene-related peptide (GGRP) receptor. Areas covered: This manuscript was based on articles written in English located on PubMed using the following search terms: episodic and chronic migraine, migraine prophylaxis and prevention, CGRP, CGRP receptor, CGRP receptor antagonist, erenumab, treatment failures, and trigeminal nerve. ⋯ This antibody also shows efficacy in a prior preventive treatment failure population. The tolerability of erenumab is good, which is reflected by low dropout rates in all erenumab clinical trials. Within the first year of treatment, no specific group or type of adverse events were observed.
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Expert Rev Neurother · Aug 2019
ReviewShedding light on migraine with aura: the clarifying role of advanced neuroimaging investigations.
Introduction: While migraine with aura is a complex neurological syndrome with a well-characterized clinical phenotype, its pathophysiology still has grey areas which could be partially clarified by microstructural and functional neuroimaging investigations. Areas covered: This article, summarizing the most significant findings from advanced neuroimaging studies, aims to achieve a unifying pathophysiological model of the migraine aura. ⋯ Expert opinion: Converging evidence from advanced neuroimaging investigations underlined the critical role of the extrastriate visual cortex, and in particular the lingual gyrus, in the genesis of the aura phenomenon. However, the relationship between the aura and the headache phase of migraine attacks has not been completely clarified, to date, and underlying pathophysiological mechanisms need to be further elucidated.
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Expert Rev Neurother · Aug 2019
ReviewFremanezumab as a preventive treatment for episodic and chronic migraine.
Introduction: The importance of calcitonin gene-related peptide (CGRP) in migraine pathogenesis is well established. Fremanezumab is a humanized IgG2a monoclonal antibody that binds to CGRP. Areas covered: In this paper, we review the development of fremanezumab, from early development into approval. ⋯ Expert opinion: Fremanezumab was shown to be effective in episodic and chronic migraine, with a monthly and quarterly dose of administration, as monotherapy and add-on therapy. As with other monoclonal antibodies, the anti-CGRP onset of action was remarkably quick, and the effect seems to be maintained over time. No overt safety concerns emerged from the clinical studies, although long-term surveillance is necessary.