Tabla I. Características generales de las moléculas pequeñas y anticuerpos monoclonales antipéptido relacionado con el gen de la calcitonina. |
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Moléculas pequeñas |
Anticuerpos monoclonales |
|
Afinidad |
Escasa |
Alta |
Eliminación |
Renal y hepática |
Sistema reticuloendotelial |
Tamaño |
<1 kD |
≈150 kD |
Administración |
Oral |
Subcutánea/intravenosa |
Barrera hematoencefálica |
Sí |
No |
Vida media |
Minutos/horas |
Semanas |
Inmunogenicidad |
No |
Sí |
Tabla adaptada de [28]. |
Tabla II. Características de los anticuerpos monoclonales aprobados para el tratamiento de la migraña episódica y crónica. |
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Eptinezumab (ALD403) |
Erenumab (AMG334) |
Fremanezumab (TEV-48125) |
Galcanezumab (LY2951742) |
|
Diana |
CGRP |
Receptor del CGRP |
CGRP |
CGRP |
Molécula |
Anticuerpo humanizado IgG1 |
Anticuerpo humano IgG2 |
Anticuerpo humanizado IgG2 |
Anticuerpo humanizado IgG4 |
Vida media |
32 días |
28 días |
30 días |
27 días |
Dosificación |
Trimestral |
Mensual |
Mensual/trimestral |
Mensual |
Vía de administración |
Endovenosa |
Subcutánea |
Subcutánea |
Subcutánea |
Anticuerpos antifármaco |
14% |
6,3% (70 mg) 2,6% (140 mg) a |
2% b,d |
12,5% c,d |
Efectos adversos frecuentes |
Mareo; infección respiratoria; infección urinaria; fatiga; náuseas; sinusitis |
Dolor en el punto de inyección; estreñimiento; prurito; espasmos |
Dolor en el punto de inyección; eritema; prurito |
Dolor en el punto de inyección; prurito; vértigo; estreñimiento |
Interacción con enzimas hepáticas |
No |
No |
No |
No |
Barrera hematoencefálica |
No |
No |
No |
No |
Placenta |
Sí |
Sí |
Sí |
Sí |
Especificidad |
Alta |
Alta |
Alta |
Alta |
CGRP: péptido relacionado con el gen de la calcitonina; IgG: inmunoglobulina de tipo G. (Tabla adaptada de [27]). a Erenumab 70/140 mg solución inyectable para jeringuilla precargada (resumen de las características del producto). b Fremanezumab 225 mg solución inyectable para jeringuilla precargada (resumen de las características del producto). c Galcanezumab 120 mg solución inyectable para jeringuilla precargada (resumen de las características del producto). d A un año. |
1st Post-European Headache Federation Meeting: a review of the latest developments presented at the 2020 European Headache Federation Congress Introduction. After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. Development. The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. Conclusions. The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020. Key words. Chronic migraine. EHF. Episodic migraine. Fremanezumab. Headache. Migraine. Post-EHF. |