Monoclonal Antibodies Against CGRP

Calcitonin gene-related peptide (CGRP) in humans exists in two forms: α-CGRP and β-CGRP. α-CGRP is a 37-amino acid neuropeptide produced in both peripheral and central neurons. It is a potent peptide vasodilator and can function in the transmission of pain.

Since April of 2018 there are new medicines on the market that contain antibodies against CGRP. They are called monoclonal antibodies (MABs) and are large molecules that do not cross the blood-brain barrier, do not interact with other drugs and have a longer half-life than many chemical drugs.

These drugs must be given parenterally (preferably by injection) to be absorbed properly by the body.
CGRP-MABs have been proved to be effective in migraine patients both with and without aura, and both episodic and chronic migraineurs. These are the first class of preventive medications originally designed and approved for migraineurs.

The first approved by the FDA is called Erenumab (trade name Aimovig) it blocks the CGRP receptor. It is injected SC once monthly with a dose of 70 or 140MG.

The second approved by the FDA is called Fremanezumab (trade name Ajovy). It blocks the CGRP ligand. It may be administered SC monthly (225mg) or every three months (675mg), giving options for users.

The third approved by the FDA is called Galcanezumab (trade name Emgality). It also blocks the CGRP ligand. It is injected SC once a month (120mg), after the first month having a double dose (240mg).

The new latest drug, Eptinezumab (Vyepti), is an intravenous migraine prophylactic medication injected SC every 3 months.