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Q&A: Favoni Valentina, MD

Dr Valentina Bio

Favoni Valentina, MD

Neurologist, IRCCS of Neurological Sciences of Bologna in Italy

Could you please give a short summary of your article and its findings/conclusions?

Calcitonin gene-related peptide (CGRP) is a small molecule shown to be released during migraine attacks. In the last two years, the use of monoclonal antibodies targeting CGRP has become a concrete, valuable addition as a preventive treatment for migraine patients. Considering the action of CGRP as a highly potent vasodilator, some reasonable concerns on the impact on cardiovascular health have been raised. The article reviewed the evidence on the role of CGRP in the cardiovascular system in order to understand the possible cardiovascular effect of CGRP blockade with monoclonal antibodies in migraineurs. Despite the aforementioned cardiovascular implication, treatment with CGRP antibodies has shown no relevant cardiovascular side effects.

What are the implications of your article’s findings or the conclusions that could be drawn for practice, research, policy, or public health?

Migraine is a very disabling disorder with severe impact on patients' lives for many years and substantive costs to society in terms of healthcare costs and lost productivity. For each patient, we have to decide whether the benefits of treatment outweigh the possible risks. The cardiovascular safety of a preventive treatment is a key element to consider. With this in mind, CGRP monoclonal antibodies ore a valid option for migraine treatment.

Where do you think the knowledge gaps still lie, and what challenges does this research face in the future?

Certainly, these CGRP monoclonal antibodies class of drugs have been safe compounds for the short-term. There are significant long-term adverse effects that need to be considered after these new products entered the market. The safety profile of CGRP monoclonal antibodies in high-risk patients has to be specifically addressed in real life. We will have a better feel for the true risk in 10 years.

Finally, are there any new developments concerning the effects of CGRP on the cardiovascular system, or CGRP and migraines in general that you think are particularly exciting or compelling?

Published articles regarding CGRP monoclonal antibodies during 1‐year-treatment studies and reports on longer exposures (up to three-years) suggest ongoing safety such that cardiovascular events and adverse invents in general continue to remain infrequent.