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Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies in Migraine: Focus on Drug Interactions

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Abstract

Calcitonin gene-related peptide neurotransmission was the target for recent development of monoclonal antibodies that effectively prevent attacks of both episodic and chronic migraine. The aim of this narrative review was to offer deeper insight into drug-drug, drug-food and drug-disease interactions of monoclonal antibodies approved for prevention of migraine attacks. For this narrative review, relevant literature was searched for in MEDLINE and Google Scholar databases, covering the 1966–2023 and 2006–2023 periods, respectively. The ClinicalTrials.gov database was also searched for relevant clinical studies whose results had not been published previously in medical journals, covering 2000–2023. Monoclonal antibodies (erenumab, fremanezumab, galcanezumab and eptinezumab) augment prophylactic action of gepants and onabotulinumtoxin A and somewhat increase efficacy of triptans used to abort migraine attacks; however, their adverse reactions may also be augmented. Pharmacokinetic interactions and interactions in general with drugs used for other indications except migraine are negligible, as are drug-food interactions. However, monoclonal antibodies may worsen diseases with already weakened CGRP neurotransmission, Raynaud phenomenon and constipation. Monoclonal antibodies used for prevention of migraine do not engage in significant pharmacokinetic interactions with other drugs; however, they do engage in pharmacodynamic interactions with other anti-migraine drugs, additively augmenting their prophylactic action, but also increasing frequency and severity of adverse reactions, which are a consequence of the CGRP neurotransmission interruption.

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Authors and Affiliations

  1. Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića Street, 69, 34000, Kragujevac, Serbia

    Slobodan M. Janković & Snežana V. Janković

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Correspondence to Slobodan M. Janković.

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Partial financial support was received from the Ministry of Education, Science and Technological Development, Serbia, via Grant No. 175007/contract no. 451-03-47/2023-01/200111.

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The authors certify that they have no other relevant affiliations or financial involvement with any organization or entity with a financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Authors' Contributions

Slobodan Janković – concept of the review, literature search, quality assessment of retrieved articles, writing the manuscript, control of completed manuscript. Snežana Janković – concept of the review, literature search, quality assessment of retrieved articles, writing the manuscript, control of completed manuscript

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Janković, S.M., Janković, S.V. Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies in Migraine: Focus on Drug Interactions. Eur J Drug Metab Pharmacokinet 49, 263–275 (2024). https://doi.org/10.1007/s13318-024-00887-3

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