Erenumab in Mechanism-based Migraine Treatment

Abstract

Migraine is a type of primary headache with recurrent attacks, negatively affects the daily living activities of sufferers because of its severity, and causes a heavy economic burden. The economic, social, and physical burdens of migraine grow with the increasing frequency of headache attacks. Mechanism-based treatments are increasingly needed, especially for those with chronic migraine (CM) or episodic migraine (EM) with frequent attacks. Conventional migraine-preventive medications have been essentially developed for some other diseases and shown to be also effective against migraine headaches. Efficacy, safety, and tolerability issues limit their use for an adequate duration, and most patients are under the risk of medication-overuse headache because of the ineffectiveness of attack treatments. In recent decades, a better understanding of migraine pathophysiology has given a new direction to migraine drug research to fulfill the unmet need for the development of migraine-specific medications. Calcitonin gene-related peptide (CGRP) has attracted attention with its potential role in migraine pathogenesis and has become the focus of drug research in this area as of the 1990s. The first monoclonal antibody developed and approved for the treatment of migraine is erenumab. Being the only therapeutic antibody against the CGRP receptor, erenumab differs from the other monoclonal antibodies for migraine prevention that target the CGRP ligand. Erenumab is a fully human, immunoglobulin G2 class monoclonal antibody with no immunomodulatory effect. It blocks the CGRP receptor with high affinity and selectivity and prevents binding of the CGRP ligand to this receptor. It does not have a significant effect on other receptors in the calcitonin receptor family. Erenumab has been shown to diminish the number of migraine days and the need for attack treatment and to improve patient-reported outcomes in patients with EM and CM.