ERENUMAB-AOOE: PROMISING MONOCLONAL-ANTIBODY FOR PROPHYLAXIS OF MIGRAINE IN ADULTS

Ranjodh Jeet Singh and Kanika Kohli*

ABSTRACT

Introduction: Migraine is one form of disorder affecting the quality of life of patient and disabled brain disorder. The term chronic migraine refers to a clinical condition summarized by migranous headache on fifteen days usually per monthly episode. Most commonly patients on pharmacotherapy of migraine include Ergot derivatives, Triptans, Opioids, and Analgesics for a period range of ten days per month. Even though the pathology and physiology of migraine is not fully understood and established, but however several other risk factors which are associated as triggers of migraine are considered to deal with. The CGRP is involved in pathology and physiology of origin of neurovascular headaches viz migraine at both peripheral and central levels. The CGRP is highly expressed in trigeminal neurons (small myelinated Ad and unmyelinated C fibers) co-localized with other neuropeptides (e.g., substance P). The CGRP levels are increased into external jugular venous blood ipsilateral to pain during headache phase of migraine attack with or without aura. Also the saliva and serum CGRP levels are increased during migraine and interictally in patients with CM. Thus CGRP monoclonal antibodies are considered to target smooth muscle cells on blood vessels and glial cells and neurons located outside BBB, probably in brainstem paraventicular structures and trigeminal ganglion. Scope: Erenumab-aooe, CGRPr antagonist, being the latest approved drug administered via subcutaneous route as 70 mg per month for prophylactic regime of migraine in adult patients, the results documented as per clinical trials data are very promising and thus Erenumab-aooe is an emerging hope to improve the quality of life and make the patients able to perform their life activity with effectiveness. Conclusion: Chronic migraine is not fully treated as the pharmacotherapy response is at the poor level and also limited pharmacotherapy is available, however the emergence of Erenumab-aooe, CGRPr antagonist as the one of the latest drug approval for the prophylaxis of migraine in adults is by far the greatest scope for the better treatment module of migraine.

Keywords: CM: chronic migraine, EM: episodic migraine, LSM: least square mean, MMD: monthly migraine days, ICHD: International classification of headache disorders, CGRPr: Calcitonin gene related peptide receptor, MHD: monthly headache days.