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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2019; 77(02): 115-121
DOI: 10.1590/0004-282X20190004
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Migraine treatment: the doors for the future are open, but with caution and prudence

Tratamento da migrânea: as portas para o futuro estão abertas, mas com cuidado e parcimçnia
Abouch V. Krymchantowski 
1   Centro de Avaliação e Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil
,
Ana Gabriela Ferreira Krymchantowski
1   Centro de Avaliação e Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil
,
Carla da Cunha Jevoux
1   Centro de Avaliação e Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil
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ABSTRACT

Migraine is a burdensome disorder. Current treatments are far from ideal. Recent knowledge has been indicating targets whose antagonism may improve efficacy. It is particularly true with the calcitonin gene-related peptide (CGRP) and the monoclonal antibodies anti-CGRP can interfere with this pathway and decrease the frequency of migraine attacks. Erenumab, fremanezumab and galcanezumab have recently been approved and eptinezumab is likely to be, soon. Although efficacy figures were not spectacular, tolerability and potential higher adherence were noteworthy. However, caution must be exercised. The time frame after the studies was limited to three years and dose administration was restricted to three-monthly doses. The CGRP is present throughout the human body and migraine is a life-long disease, often requiring treatment for decades. It is not known whether this favorable profile can be maintained or will be safe in pregnant women or adolescents. In addition, there were deaths during the studies, which may have happened without a clear relationship. New treatments are welcome, but caution is warranted.

RESUMO

A migrânea é incapacitante. Os tratamentos atuais apresentam resultados abaixo do desejado. O conhecimento atual indica alvos nos quais o bloqueio pode melhorar a eficácia do tratamento. Isso é mais claro com o peptídeo relacionado ao gene da calcitonina (CGRP) e anticorpos monoclonais contra este peptídeo ou seu receptor interferem com a fisiopatologia migranosa e reduzem a frequência da cefaleia. Erenumab, fremanezumab e galcanezumab já foram aprovados. Eptinezumab o será em breve. Embora a eficácia não tenho sido espetacular, a boa tolerabilidade e melhor adesão foram notáveis. No entanto, cautela deve ser empregada. Os estudos se limitaram a observar os pacientes por até três anos e com três doses mensais seguidas. Existe CGRP em todo o organismo e a migrânea é uma doença crçnica, não raro requerendo tratamento por décadas. Não se sabe se a tolerabilidade favorável manter-se-á por anos ou em grávidas e adolescentes. Também houve mortes durante os estudos, mesmo sem ligação comprovada. Novos tratamentos são bem-vindos, mas cautela é necessária neste momento.

Keywords:

Migraine - therapeutics - upcoming treatments - antibodies - monoclonal

Palavras-chave:

Enxaqueca - terapêutica - novos tratamentos - anticorpos monoclonais


Publication History

Received: 13 August 2018

Accepted: 21 November 2018

Article published online:
21 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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