From the Guidelines
There are no clinical trials specifically investigating the trans-arterial infusion of anti-CGRP medications as of the latest evidence available in 2024 1.
Background
Anti-CGRP treatments, such as erenumab, fremanezumab, galcanezumab, and eptinezumab, are administered either subcutaneously or intravenously, not through trans-arterial routes. The most recent guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense, published in 2023 and reviewed in 2024 1, does not mention trans-arterial infusion as a method of administration for these medications.
Current Administration Routes
- Eptinezumab is the only FDA-approved intravenous anti-CGRP medication, administered as a 30-minute infusion every 3 months.
- Other anti-CGRP medications are administered subcutaneously.
Rationale for Current Routes
The rationale for the current administration routes relates to the mechanism of action of these medications, which target either the CGRP peptide itself or its receptor systemically to prevent migraine attacks. Systemic administration allows these medications to reach their targets throughout the nervous system, which is crucial for their effectiveness in preventing migraine attacks.
Considerations for Trans-arterial Delivery
- Technically challenging: Trans-arterial delivery of anti-CGRP medications would be more complex compared to the current subcutaneous or intravenous routes.
- Lack of advantages: Since these medications need to act systemically, targeting specific arterial territories may not offer additional benefits over current administration methods.
- Increased risks: Trans-arterial administration could increase the risk of arterial complications, such as thrombosis or vasospasm, compared to the safer routes currently in use.
Conclusion Based on Current Evidence
Given the information available up to 2024 1, and considering the morbidity, mortality, and quality of life outcomes, the current standard administration routes for anti-CGRP medications should be preferred over any hypothetical trans-arterial infusion method due to their established safety and efficacy profiles. Any consideration of alternative administration routes would require rigorous clinical trials to demonstrate safety and effectiveness.
From the Research
Trials on Anti-CGRP Medication Infusion
- There are no studies found that specifically investigate anti-CGRP medication infusion via a trans-arterial approach 2, 3, 4, 5, 6.
- The existing studies focus on the use of anti-CGRP monoclonal antibodies for migraine headache prophylaxis, neuropathic pain, and cluster headache prevention, but do not explore trans-arterial infusion as a method of administration.
- The studies provide evidence on the efficacy of anti-CGRP medications in reducing migraine frequency, improving neuropathic pain, and preventing cluster headaches, but do not address the specific question of trans-arterial infusion 2, 3, 4, 5, 6.
Methods of Administration
- The studies found investigate the use of anti-CGRP monoclonal antibodies administered via subcutaneous injection or intravenous infusion, but not trans-arterial infusion 2, 3, 4, 5, 6.
- Further research is needed to explore the potential benefits and feasibility of trans-arterial infusion of anti-CGRP medications.