Combining treatments for migraine prophylaxis: the state-of-the-art.

Autor: Pellesi L; Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark. lpellesi@health.sdu.dk., Garcia-Azorin D; Department of Medicine, Toxicology and Dermatology, Faculty of Medicine, University of Valladolid, Valladolid, Spain.; Department of Neurology, Hospital Universitario Río Hortega, Valladolid, Spain., Rubio-Beltrán E; Headache Group, Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom., Ha WS; Department of Neurology, Yonsei University College of Medicine, Seoul, Korea., Messina R; Neuroimaging Research Unit and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy., Ornello R; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Petrusic I; Laboratory for Advanced Analysis of Neuroimages, Faculty of Physical Chemistry, University of Belgrade, Belgrade, Serbia., Raffaelli B; Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.; Clinician Scientist Program, Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany., Labastida-Ramirez A; Division of Neuroscience, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom., Ruscheweyh R; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany., Tana C; Center of Excellence on Headache, Geriatrics Clinic, Ss. Annunziata of Chieti, Italy., Vuralli D; Department of Neurology and Algology, Faculty of Medicine, Gazi University, Ankara, Türkiye.; Neuropsychiatry Center, Gazi University, Ankara, Türkiye.; Neuroscience and Neurotechnology Center of Excellence (NÖROM), Gazi University, Ankara, Türkiye., Waliszewska-Prosół M; Department of Neurology, Wroclaw Medical University, Wroclaw, Poland., Wang W; Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.; Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China., Wells-Gatnik W; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
Jazyk: angličtina
Zdroj: The journal of headache and pain [J Headache Pain] 2024 Dec 05; Vol. 25 (1), pp. 214. Date of Electronic Publication: 2024 Dec 05.
DOI: 10.1186/s10194-024-01925-w
Abstrakt: Combination treatments for migraine prophylaxis present a promising approach to addressing the diverse and complex mechanisms underlying migraine. This review explores the potential of combining oral conventional prophylactics, onabotulinumtoxin A, monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway, and small molecule CGRP receptor antagonists (gepants). Among the most promising strategies, dual CGRP inhibition through mAbs and gepants may enhance efficacy by targeting both the CGRP peptide and its receptor, while the combination of onabotulinumtoxin A with CGRP treatments offers synergistic pain relief. Oral non-CGRP treatments, which are accessible and often prescribed for patients with comorbid conditions, provide an affordable and practical option in combination regimens. Despite the potential of these combinations, there is a lack of evidence to support their widespread inclusion in clinical guidelines. The high cost of certain combinations, such as onabotulinumtoxin A with a CGRP mAb or dual anti-CGRP mAbs, presents feasibility challenges. Further large-scale trials are needed to establish safe and effective combination protocols and solidify their role in clinical practice, particularly for treatment-resistant patients.
Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: LP has been employed by Lundbeck in the past two years. DGA has received honoraria for lectures and presentations from AbbVie/Allergan, Eli Lilly, Teva, Lundbeck, and Novartis and has participated in clinical trials as the principal investigator for Pfizer, BioHaven, and Lundbeck. DGA has also received honoraria from the World Health Organization as a subject matter expert. RM reports personal fees from AbbVie, Eli Lilly, Lundbeck, Pfizer, Teva, and Biomedia, outside the submitted work. IP serves as Head of Imaging Section of SN Comprehensive Clinical Medicine. BR reports research grants from Lundbeck, Novartis, the German Research Foundation, the German Migraine and Headache Society, and Else Kröner-Fresenius Stiftung, as well as personal fees from AbbVie/Allergan, Lilly, Lundbeck, Novartis, Perfood, and Teva. RR has received travel grants and/or honoraria from Allergan/AbbVie, Lilly, Lundbeck, Novartis, Pfizer, and Teva. WW serves as Section Editor of SN Comprehensive Clinical Medicine. All authors serve as junior editors of The Journal of Headache and Pain.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: