Fremanezumab for the preventive treatment of migraine in adults

ABSTRACT

Introduction: The Calcitonin Gene-Related Peptide (CGRP) has been implicated in migraine pathophysiology due to its role in neurogenic inflammation and transmission of trigeminovascular nociceptive signal. New molecules targeting CGRP and its receptor have been developed as migraine-specific preventative treatments. Fremanezumab (or TEV-48,125, LBR-101), a human monoclonal antibody against CGRP, has been recently approved for clinical use by FDA and EMA.

Areas covered: This paper briefly discusses the calcitonin family of neurotransmitters and resultant activation pathways and in-depth the chemical properties, pharmacodynamics, pharmacokinetics, clinical efficacy and safety of Fremanezumab for the prophylactic treatment of migraine.

Expert opinion: Fremanezumab, a migraine-specific drug, is effective and safe as a prophylactic treatment of chronic and episodic migraine. As a monoclonal antibody, it was not associated to liver toxicity and is not expected to interact with other drugs. The long half-life might improve patients’ compliance. Long-term effects of CGRP block in cardiovascular, grastrointestinal and bone functions should be evaluated in ongoing trials, since CGRP is involved in multiple biological activities in the human body. Nevertheless, targeting CGRP itself allows the receptor binding with other ligands involved in several physiological functions. Thus, the long-term treatment with Fremanezumab is expected to be associated with a lower risk of severe adverse effects.

KEYWORDS:

• Fremanezumab
• migraine
• headache
• monoclonal antibody
• CGRP

Article Highlights

• CGRP plays a key role in migraine pathophysiology by mediating the neurogenic inflammation and the transmission of pain.

• Drugs targeting the Calcitonin Gene-Related Peptide (CGRP) and its receptor have been recently developed for migraine treatment.

• Fremanezumab is a humanized monoclonal antibody approved for the prevention of migraine.

• Fremanezumab has a good efficacy profile for episodic and chronic migraine treatment.

• Fremanezumab shows a very low incidence of adverse events, mostly regarding injection-site reactions.

Declaration of interest

P Martellenti discloses honoraria and travel grants by Allergan, TEVA, Novartis and Eli Lilly. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

A reviewer on this manuscript has disclosed that they are on the speaker’s bureau for Amgen, Lilly, and Teva as well as Allergan. I have done research for amgen, Teva and Alder and been a consultant to Allergan. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.