CGRP Education & Research Forum
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Anti-CGRP therapy: where does it fit in our clinics?

With anti-CGRP therapy rapidly becoming available to clinicians, it’s a good time to consider where it fits within our therapeutic options for migraine, says Professor David Dodick, from the Mayo Clinic, Scottsdale, Phoenix, Arizona, USA. In the USA, erenumab, fremanezumab and galcanezumab are approved for the preventive treatment of migraine in adults, while the EU licence …

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My reflections on CGRP-targeted monoclonal antibody therapy

Migraine is not only a common disease but also one of the most disabling brain disorders, explains Mamoru Shibata, MD, PhD Department of Neurology, Keio University School of Medicine, Tokyo, Japan. According to the Global Burden of Disease Study 2015, migraine is the second largest contributor of disability-adjusted life-years (DALYs) in neurological diseases1. Migraine affects chiefly …

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Monoclonal antibodies: sites of action

There are four mAbs currently in development; three are humanized mAbs targeting the CGRP ligand and one is a fully human mAb against the CGRP receptor. They have a rapid onset of efficacy (roughly one week) following a single dose administration. All are thought to work peripherally. Therapeutic mAbs are designed to achieve high target …

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Sex dependent sensitivity to CGRP

Recent studies reported by Dr Greg Dussor (University of Texas, Dallas) at the 2017 American Headache Society meeting in Boston, USA, have opened up an exciting new perspective on CGRP actions. Dr Dussor’s unexpected finding is that CGRP can directly stimulate the dura of female, but not male, rodents to cause periorbital hypersensitivity. First a …

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Responders and super-responders in migraine prophylaxis trials: definition, distribution and consequences for practice

No biomarker or imaging technique is currently available to quantify migraine. To this day, the outcomes of therapeutic interventions are still based on headache diaries. Multiple techniques have been used to analyse results, but the mean decrease in headache days (including headache, migraine, probable migraine and moderate/severe days) and the 50% response rate have been …

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CGRP and metabolism: another factor to consider when blocking CGRP?

We should not forget the potential off-target metabolic effects of CGRP inhibitors, say Christopher S Walker and Debbie L Hay of the School of Biological Sciences, The University of Auckland, New Zealand The major concern when considering the possible off-target effects of blocking CGRP activity in migraine with small molecule antagonists or antibodies, appears to be …

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A novel tool for exploring calcitonin gene-related peptide mechanisms in primary headaches

Novel CGRP-targeted small molecule antagonists and monoclonal antibodies are making giant strides in clinical trials, but to date there has been little insight into the basic mechanisms of CGRP.  Dr Philip R Holland, Lecturer in Neuroscience at King’s College, London discusses a new stable CGRP analogue that offers the possibility of exploring underlyIng and central …

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Targeting the CGRP receptor or ligand: does it make a difference?

As a novel migraine therapeutic approach, monoclonal antibodies against CGRP or its receptor are currently in clinical trials for migraine prophylaxis. The key question then is: Does it make a difference whether we choose the CGRP receptor or CGRP itself as a therapeutic target? This is hard to answer. Intuitively, blocking the receptor is likely …

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Drug efficacy should not be used as a diagnostic criterion for headaches

Headache is a highly complex condition and thus cannot be explained by a single mechanism. There are no biomarkers for headache, and no effective diagnostic tests which are universally applicable. For instance, the International Classification of Headache Disorders (ICHD) criteria for conditions such as chronic migraine (CM), hemicrania continua (HC) and Tolosa‐Hunt syndrome (THS) require …

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Migraine, Obesity, and Calcitonin Gene-Related Peptide (CGRP): is there a link?

The risk of migraine increases in people who are overweight or obese. Now, there is emerging evidence that Calcitonin Gene-Related Peptide (CGRP) may mediate this link. Professor B. Lee Peterlin, Director of Johns Hopkins Headache Research, Johns Hopkins School of Medicine, Baltimore, USA discusses this issue.  People who are overweight or obese are more likely …

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