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European Headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention – 2022 update
Authors:Simona Sacco  Faisal Mohammad Amin  Messoud Ashina  Lars Bendtsen  Christina I. Deligianni  Raquel Gil-Gouveia  Zaza Katsarava  Antoinette MaassenVanDenBrink  Paolo Martelletti  Dimos-Dimitrios Mitsikostas  Raffaele Ornello  Uwe Reuter  Margarita Sanchez-del-Rio  Alexandra J. Sinclair  Gisela Terwindt  Derya Uluduz  Jan Versijpt  Christian Lampl
Abstract:
BackgroundA previous European Headache Federation (EHF) guideline addressed the use of monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway to prevent migraine. Since then, randomized controlled trials (RCTs) and real-world evidence have expanded the evidence and knowledge for those treatments. Therefore, the EHF panel decided to provide an updated guideline on the use of those treatments.MethodsThe guideline was developed following the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed a systematic review and an analysis of the literature, assessed the quality of the available evidence, and wrote recommendations. Where the GRADE approach was not applicable, expert opinion was provided.ResultsWe found moderate to high quality of evidence to recommend eptinezumab, erenumab, fremanezumab, and galcanezumab in individuals with episodic and chronic migraine. For several important clinical questions, we found not enough evidence to provide evidence-based recommendations and guidance relied on experts’ opinion. Nevertheless, we provided updated suggestions regarding the long-term management of those treatments and their place with respect to the other migraine preventatives.ConclusionMonoclonal antibodies targeting the CGRP pathway are recommended for migraine prevention as they are effective and safe also in the long-term.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-022-01431-x.
Keywords:Monoclonal antibodies   Calcitonin gene-related pathway   Guideline   Migraine   Prevention
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