Lessons on the side effects of CGRP antibodies in migraine

Lawrence Robbins, MD, Robbins Headache Clinic, Riverwoods, IL, discusses the safety profile of CGRP-directed antibodies in migraine and how clinical studies can be improved. After 3 years, 50,000 adverse events in migraine patients receiving CGRP-directed antibodies have been reported by the FDA. Many side effects of CGRP therapy, such as constipation and hypertension, have emerged after initial studies predicted a much milder safety profile. This may be explained by clinical trials often lacking a checklist for adverse events, which has been associated with missed side effects in 67% of patients. Studies are also often underpowered by cohort size and time. Overall, clinical trials need to be improved to more accurately represent potential side effects. The short- and long-term side-effects of CGRP antibodies in migraine need to be uncovered. This interview was conducted during the virtual 2021 World Congress on Controversies in Neurology (CONy) meeting.