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Title: Inflammatory complications of CGRP monoclonal antibodies: a case series.
Austin Authors: Ray, Jason C ;Allen, Penelope;Bacsi, Ann;Bosco, Julian J;Chen, Luke;Eller, Michael;Kua, Hock;Lim, Lyndell L;Matharu, Manjit S;Monif, Mastura;Ruttledge, Martin;Stark, Richard J;Hutton, Elspeth J
Affiliation: Department of Allergy, asthma and clinical immunology, Alfred Hospital, Commercial Road 3004, Melbourne, Australia
Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Australia
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia
Otoneurology Diagnostic Unit, Alfred Hospital, Commercial Rd 3004, Melbourne, VIC, Australia
Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia
Integrated Specialist Medical Care, Sydney, Australia
Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
Department of Neurology, Monash Medical Centre, Vic, Melbourne, Australia
School of Clinical Sciences, Monash University, Vic, Melbourne, Australia
Department of Pathology, Monash Medical Centre, Vic, Melbourne, Australia
Department of Neurology, Royal Melbourne Hospital, Vic, Parkville, 3050, Australia
MS and Neuroimmunology Department, Alfred Hospital, Vic, Melbourne, 3004, Australia
University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, University College London, Gower Street WC1E 6BT, London, UK
Consultant Neurologist & Headache Clinical Lead, Beaumont Hospital, Beaumont Road, Dublin, Ireland
Issue Date: 9-Oct-2021
Date: 2021-10-09
Publication information: The Journal of Headache and Pain 2021; 22(1): 121
Abstract: Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb)┬átargeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.
DOI: 10.1186/s10194-021-01330-7
ORCID: 0000-0003-4833-5507
Journal: The Journal of Headache and Pain
PubMed URL: 34625019
Type: Journal Article
Subjects: Autoimmune diseases
CGRP receptor antagonists
Drug-related side effects and adverse reactions
Monoclonal antibodies
Appears in Collections:Journal articles

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