An Evidence-Based Review of Galcanezumab for the Treatment of Migraine

Abstract

Purpose of Review This is a comprehensive review of the current literature on the usage of galcanezumab for migraine treatment. It reviews the biology, pathophysiology, epidemiology, diagnosis, and conventional treatment of migraines, then compares the literature available for galcanezumab with historical treatment options. Recent Findings Migraine is a common headache disorder and constitutes a significant source of distress from both a personal and societal perspective. Conventional treatment includes abortive and preventive treatment. Treatment options are limited and may be only partially or minimally effective in some of the population. Recent evidence points to metabolic changes in the brain as possible causes of migraine, via reduced available energy or a spiking need for it, resulting in a relative insufficiency. This leads to trigeminocervical complex (TCC) activation and a headache episode, modulated by calcitonin gene-related peptide (CGRP). Galcanezumab (Emgality) is a monoclonal antibody targeting CGRP that is given in a monthly injection for the prevention of migraines. Its safety was previously shown in phase 1 and 2 trials, and recent phase 3 trials showed efficacy, with up to 50% reduction in monthly migraine days and improved functional capacity in migraineurs. Studies show that the drug is well tolerated and safe. Summary Migraine headache is a common neurological syndrome that causes great pain and suffering. Treatment options today are limited. Galcanezumab does not prevent migraines, but it is effective in decreasing their frequency and length. It is also much better tolerated than the currently existing therapies. While it is unlikely to provide monotherapy for migraines, it is a novel therapy that may be added for cases of severe or frequent migraines.

Mass Spectrometry Approaches Empowering Neuropeptide Discovery and Therapeutics

“…For example, CGRP, a potent vasodilator involved in nociception, appetite regulation, and temperature regulation, was extensively characterized by several groups via ISH and IHC (Kresse et al, 1992;Van Rossum et al, 1997). Better understanding of the localization of CGRP mRNA in various neuroanatomical regions and CGRP-like immunoreactivity eventually led to the development of drugs for migraine that target the CGRP peptide and its receptor, such as fremanezumab (Silberstein et al, 2017), galcanezumab (Urits et al, 2020), and erenumab (Andreou et al, 2020).…”

Spatial Distribution Analysis of Cannabis-Infused Food and Drink Establishments in Pathum Thani Province, Thailand Through Geographic Information Systems

“…This area has many universities and most of them are located in urban areas [24]. The population of this study lived in urban areas and they had various population characteristics, that related to health behavior and can lead to the intake of cannabis-infused food and drink among undergraduate students [25].…”

Tobacco and cannabis co-use : toxicity, dependence and cessation management.

“…Cannabis use in young people, compared with no use, was not significantly associated with the risk of developing anxiety, but with that of depression (OR = 1.37 ; 95% CI, 1.16-1.62) and suicide (OR = 3.46 ; 95% CI, 1.53-7.84). Psychotic-type thought disorganization syndromes can occur in subjects with no psychiatric history [68] and cannabis use appears to participate with other risk factors in the occurrence of schizophrenia [69] ; it is estimated that one in four schizophrenic patients has consummed cannabis, which would be an unfavourable factor in the course of the illness [70,71].…”