What is the aim of the guideline and what is the European Headache Federation (EHF) hoping to achieve for patients and physicians?
几项试验测试了新的抗CGRP单克隆抗体的功效和安全性。目的guidelinewas to summarize the available evidence and provide patients and physicians with indications for treatment with anti-CGRP monoclonal antibodies just before their commercialization.
您想挑选相关示例以说明准则的重要性吗？
When putting new treatments into clinical practice, one of the most important considerations is patient selection. Migraine preventive treatment is traditionally based upon the patient’s comorbidities; for example, you might use an antidepressant in a patient with migraine and comorbid depression symptoms, while you might prefer a beta-blocker in a hypertensive migraineur. Problems usually arise when the available treatments must be withdrawn because of adverse events, when patients have failed several preventive treatments, or when the patients have comorbidities that contraindicate migraine preventive treatments. In those cases, anti-CGRP monoclonal antibodies may be a safe and effective treatment option.
在您看来，最重要的目标是什么？
我认为该指南将向临床医生展示抗CGRP单克隆抗体的相关性，并为其提供实用的适应症。
Tell us more about the process and efforts of getting this document together, how long did it take and what challenges did the EHF group encounter?
It took about 6 months to the EHF group to write the guideline. The first step of the process was the systematic literature search, from which we extracted the trial results. I think the most challenging part for the EHF group was to periodically update the literature search, as several trials were published just in the last months.
Acorrectionto the guideline was recently published. Could you please explain why a correction was needed?
The answer to this question is linked to the previous one, as the correction was, in fact, an update. The recent EVOLVE-2 trial about galcanezumab 120 or 240 mg monthly for the prevention of episodic migraine was left out due to its recency. The EHF working group deemed it important to update the current guidelines with the inclusion of that trial.
Did the level of evidence for those treatments change after the correction?
After the inclusion of the EVOLVE-2 trial, which replicated the results of the EVOLVE-1 trial, the level of evidence of galcanezumab for the prevention of episodic migraine increased from moderate to high.
Did the strength of recommendation for that treatment change after the correction?
否。强烈建议所有针对降钙素基因相关肽或其受体的单克隆抗体，以预防发作性和慢性偏头痛，因为它们的高效率和出色的耐受性。
What do you expect from the corrected guideline?
我认为，该指南及其更新将导致头痛医学的重大变化。
更正或更好地更新了该指南，证明该领域正在大大扩展。我们期望Eptinezumab的试验预防发作性和慢性偏头痛以及其他抗CGRP单克隆抗体的商业化。我认为，该指南及其更新将导致头痛医学的重大变化。
Raffaele Ornellois a neurologist and PhD student at the University of L’Aquila, Italy. His main interests are headache medicine and cerebrovascular diseases from an epidemiological perspective.
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