This review compares the four anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) for migraine prevention, examining their efficacy, safety profiles, and impact on prophylactic antimigraine medication prescribing patterns.
4 antibodies availableErenumab, fremanezumab, galcanezumab, and eptinezumab are all FDA-approved anti-CGRP antibodies for migraine prevention — the first disease-specific preventive treatments for migraine
What the researchers found
Anti-CGRP monoclonal antibodies represent a paradigm shift in migraine prevention as the first treatments designed specifically for migraine. All four (erenumab, fremanezumab, galcanezumab, eptinezumab) have demonstrated efficacy in clinical trials.
Why it matters
Understanding how these antibodies compare helps patients and clinicians choose the most appropriate option and understand how they fit alongside existing migraine preventive treatments.
The numbers in context
4 mAbs; 3 target CGRP; 1 targets CGRP receptor; do not cross BBB; hepato-friendly
How the study worked
Narrative review of clinical trial data, prescribing patterns, and safety profiles for anti-CGRP monoclonal antibodies in migraine prevention.
Who was studied
Adults with migraine (episodic and chronic)
What this study cannot tell us
Narrative review. Limited head-to-head comparison data between the four antibodies. Long-term safety data still accumulating. Cost and access remain barriers for many patients.
How to read the evidence
Not applicable (narrative review). Based on high-quality Phase 3 clinical trial data for each antibody.
When this study was published
Published 2021. Real-world evidence for anti-CGRP antibodies continues to accumulate with broader clinical experience.
The bigger picture
Anti-CGRP antibodies validate decades of CGRP research and represent a new era in migraine medicine. Their success is encouraging development of next-generation CGRP-pathway treatments including small molecule oral gepants.
Questions still open
- Which anti-CGRP antibody is best for which type of migraine patient?
- Does switching between anti-CGRP antibodies benefit non-responders?
- What are the long-term safety implications of chronically blocking CGRP?
Common questions
How do I choose between the four migraine antibodies?
Are anti-CGRP antibodies safe long-term?
Read the original research
The impact of CGRPergic monoclonal antibodies on prophylactic antimigraine therapy and potential adverse events.
Expert opinion on drug metabolism & toxicology, 17(10), 1223-1235
Citation
González-Hernández, Abimael; Marichal-Cancino, Bruno A; Villalón, Carlos M. (2021). The impact of CGRPergic monoclonal antibodies on prophylactic antimigraine therapy and potential adverse events.. Expert opinion on drug metabolism & toxicology, 17(10), 1223-1235. https://doi.org/10.1080/17425255.2021.1982892