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Liệu pháp nhắm mục tiêu CGRP cho chứng đau nửa đầu mãn tính - Bằng chứng từ các thử nghiệm lâm sàng và nghiên cứu thực tế
Tóm tắt
Các kháng thể đơn dòng chống lại peptide liên quan đến gen calcitonin (CGRP) hoặc thụ thể của nó đã trở thành một phần trong điều trị tiêu chuẩn cho chứng đau nửa đầu trong thực hành lâm sàng. Bài tổng quan hiện tại tập trung vào bằng chứng lâm sàng về các kháng thể đơn dòng CGRP ở những bệnh nhân mắc chứng đau nửa đầu mãn tính (CM), bao gồm cả những trường hợp khó khăn hơn. Các kháng thể đơn dòng CGRP hiệu quả hơn giả dược trong việc giảm số ngày đau nửa đầu hàng tháng (MMDs), và sự thay đổi tương đối so với giả dược trong nhóm điều trị là từ −1.2 đến −2.7 ngày sau 3 tháng. Các kháng thể đơn dòng CGRP dẫn đến phản ứng ≥50% ở 27.5 đến 61.4% bệnh nhân và làm tăng gấp đôi khả năng có được phản ứng ≥50%. Những phát hiện này nhìn chung nhất quán ở những bệnh nhân có kèm theo lạm dụng thuốc hoặc thất bại điều trị với nhiều loại thuốc dự phòng, bao gồm onabotulinumtoxinA. Kết quả từ các nghiên cứu thực tế (RWS) tương tự như những gì được thấy trong các thử nghiệm lâm sàng, và sự thay đổi từ mức cơ bản về số ngày MMDs và tỷ lệ phản ứng chủ yếu nằm trong các giới hạn của những gì đã báo cáo trong nhóm điều trị trong các thử nghiệm then chốt. Các tác dụng điều trị thường bắt đầu trong vài ngày và duy trì ổn định sau khi điều trị thường xuyên lên tới 1 năm. Những tác nhân này thường được dung nạp tốt, và tỷ lệ ngừng điều trị do các sự kiện bất lợi trong các thử nghiệm lâm sàng và trong nhiều RWS là <4.5%. Các kháng thể đơn dòng CGRP là hiệu quả và an toàn trong việc điều trị bệnh nhân mắc chứng CM, bao gồm cả các trường hợp lâm sàng khó khăn. Tuy nhiên, vai trò của các kháng thể đơn dòng CGRP trong một số tình trạng như bệnh tim mạch hoặc bệnh mạch máu não, mang thai, và tình trạng lạm dụng opioid hoặc barbiturat cần được làm rõ thêm.
Từ khóa
#kháng thể đơn dòng CGRP #chứng đau nửa đầu mãn tính #điều trị chứng đau nửa đầu #nghiên cứu thực tế #thử nghiệm lâm sàngTài liệu tham khảo
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