PURPOSE OF REVIEW: Monoclonal antibodies (mAbs) targeting the 
calcitonin-gene-related peptide (CGRP) pathway have been developed for episodic 
and chronic migraine prevention, either through binding the CGRP ligand 
(eptinezumab, fremanezumab, galcanezumab) or the CGRP receptor (erenumab). We 
provide an update on published Phase 2 and Phase 3 trials, safety/tolerability 
data, pharmacokinetics and mechanism of action of these biologicals.
RECENT FINDINGS: The efficacy data from Phase 2 trials are corroborated by those 
from published Phase 3 trials, with a multitude of publications expected in 
2018. Review of safety data concluded there was no difference in total adverse 
events or main adverse events (including upper respiratory tract infection, 
nasopharyngitis, nausea, injection-site pain and back pain) between the mAbs and 
placebo injections except apparently for dizziness. The site of action of these 
mAbs is not fully elucidated but current insight is that their effect resides in 
the periphery; a contribution of central effect(s) can however not be excluded 
at present.
SUMMARY: Although efficacy of all four drugs is modest over placebo in episodic 
and chronic migraine prevention and overall comparable with available oral 
preventive treatments, current tolerability and (short-term) safety data of this 
new treatment approach certainly promise a major step forward for migraine 
patients.