Neue medikamentöse und neuromodulatorische Therapieansätze zur Behandlung der Migräne

Zusammenfassung

Trotz vorhandener Therapiemöglichkeiten sind die Wirksamkeit und Verträglichkeit vieler Präparate zur Behandlung der Migräne oftmals unbefriedigend und unzureichend. Daher liegen die Hoffnungen vieler Patienten und Behandler auf neuen Medikamenten und neuromodulatorischen Behandlungsansätzen, die derzeit in klinischen Studien getestet werden. In der Akuttherapie der Migräne wurden und werden verschiedene Präparate untersucht, die u. a. am CGRP-, TRPV1-, Glutamat- oder GABAA-Rezeptoren angreifen. Die bisher veröffentlichten Studienergebnisse sind leider weniger vielversprechend als die ursprünglichen prä-klinischen Daten vermuten ließen. Die besten Studienergebnisse liegen bezüglich humanisierter Antikörper gegen CGRP sowie den CGRP-Rezeptor vor, die in der prophylaktischen Therapie der Migräne eingesetzt werden können. Auch für Candesartan liegen Studienergebnisse vor, die den Einsatz in der prophylaktischen Migränetherapie rechtfertigen. Die vorliegenden Studienergebnisse zum Einsatz neuromodulativer Verfahren sind bislang widersprüchlich. Insbesondere invasive Verfahren sollten der chronischen Migräne vorbehalten sein und nur im Rahmen klinischer Studien eingesetzt werden.

Abstract

Despite various therapeutic options in the drug treatment of migraine, the treatment outcome is often unsatisfactory and insufficient. Many patients and doctors therefore are hoping for new migraine drugs as well as neuromodulatory approaches which are currently being investigated in clinical studies. Several drugs are being tested for acute migraine therapy, targeting the CGRP, TRPV1, glutamate or GABAA receptor. Unfortunately, the results of the clinical trial were less promising than preclinical data let assume. The most efficient drug seems to be humanized antibodies against CGRP or its receptor which can be used for prophylactic migraine treatment. Candesartan might be also efficient in the prophylactic treatment if first-line medication shows no efficacy or cannot be used because of side effects or contraindications. Clinical data on the efficacy of neuromodulatory approaches are rather inconsistent. Especially invasive approaches should only be used in chronic migraine and within clinical trials.

Schlüsselwörter

Migräne - CGRP - Neuromodulation

Keywords

migraine - CGRP - neuromodulation

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