Real world evidence on the efficacy and safety of CGRP monoclonal Abs inmigraine

Migraine is a prevalent disorder with high disability and socioeconomic costs. Preventive treatment has beenshown to decrease headache frequency, improve quality of life and minimize the medical expenses. Althoughmany medications have been proved effective, they are underutilized. For the past several years, significantprogress has been made with the emerging options of calcitonin-gene related peptide (CGRP) monoclonalantibodies and antagonists headaches, disease-specific and mechanism-based treatments existed only forsymptomatic management of migraines (i.e., triptans), while the standard prophylactic anti-migraine treatmentsconsist of non-specific and repurposed drugs that share limited safety profiles and high risk for interactionswith other medications, resulting in rundown adherence rates. Recent advances in headache science have..increased our understanding of the role of calcitonin gene relate peptide (CGRP) in cephalic painneurotransmission and peripheral or central sensitization, leading to the development of monoclonal antibodies(mAbs) or small molecules targeting these neuropeptides or their receptors. Large uscale randomized clinicaltrials confirmed that inhibition of the CGRP system attenuates migraine. In this review, we provide the latestclinical evidence for the use of anti-CGRP in migraine prevention with emphasis on efficacy and safetyoutcomes from Phase III and real-world studies.The choices of these medications depend on not only theevidences of effects and possible side effects of the medications but also comorbidities, preferences and evenspecial considerations of the individual patient such as breast feeding and reproduction.