ATC Group: N02CD Calcitonin gene-related peptide (CGRP) antagonists

Atogepant is indicated for prophylaxis of migraine. Atogepant shows affinity to several receptors of the calcitonin/CGRP-receptor family. In view of the clinically relevant free plasma concentrations of atogepant and the fact that CGRP and amylin-1 receptors are considered to be involved in the pathophysiology of migraine, inhibitory effects of atogepant at these receptors could be of clinical relevance. However, the precise mechanism of action of atogepant in the prophylaxis of migraine remains to be established.

Erenumab is a human monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor. CGRP is a neuropeptide that modulates nociceptive signalling and a vasodilator that has been associated with migraine pathophysiology. Inhibition of the effects of CGRP could theoretically attenuate compensatory vasodilation in ischaemic-related conditions.

Fremanezumab is a humanised IgG2Δa/kappa monoclonal antibody which selectively binds the calcitonin gene-related peptide (CGRP) ligand and blocks both CGRP isoforms (α- and β-CGRP) from binding to the CGRP receptor. It is believed that prevention of migraine is obtained by its effect modulating the trigeminal system.

Galcanezumab is a humanised IgG4 monoclonal antibody that binds calcitonin gene-related peptide (CGRP) thus preventing its biological activity. Elevated blood concentrations of CGRP have been associated with migraine attacks.