Antibody-Based Biotherapeutics in Migraine

Migraine is a common, chronic, primary headache disorder characterized by attacks of headache and accompanying symptoms, with a significant personal and societal burden, requiring safe and effective, acute, and preventive treatment options in a substantial part of the patient group. Calcitonin gene-related peptide (CGRP) is a 37-amino acid neuropeptide abundant in the central nervous system. It is recognized as a pivotal neuropeptide in migraine pathophysiology. This led to the development of fully human and humanized monoclonal antibodies targeting CGRP or its receptor to block the CGRP pathway. Four anti-CGRP mAbs have been developed worldwide, with monthly to quarterly dosing protocols using the subcutaneous (three mAbs) or intravenous (one mAb) route of administration. In this chapter their mechanism of action, pharmacokinetic details, and clinical experience are discussed.