Expert Opinion: CGRP Receptor Antagonist Use in Pediatric Patients With Migraine

In 2018, the Food and Drug Administration approved several CGRP receptor antagonists
In 2018, the Food and Drug Administration approved several CGRP receptor antagonists

Recommendations on the use of calcitonin gene-related peptide (CGRP) receptor antagonists in pediatric patients to treat headache disorders are outlined in a Views and Perspectives paper published in the journal Headache.

In 2018, the Food and Drug Administration approved several CGRP receptor antagonists (erenumab-aooefremanezumab-vfrmgalcanezumab-gnlm) for the prophylaxis of migraine in adult patients. As outcome data for pediatric patients is likely years away, members of the Pediatric and Adolescent Headache special interest group of the American Headache Society put together recommendations on the use of these agents for children and adolescents with headache disorders. 

In the paper, the authors suggest that the use of CGRP receptor antagonists could be considered in postpubertal adolescent patients with frequent migraine (≥8 headache days/month), who have moderate to severe disability associated with migraine (PedMIDAS score ≥30), and who have failed ≥2 preventive therapies. For younger patients who are refractory to multiple preventive therapies, CGRP receptor antagonists may also be considered with proper monitoring (e.g., bone health, linear growth, weight/BMI, infections).

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With regard to other headache disorders, the authors note that a CGRP receptor antagonist could potentially be a “reasonable” treatment option for cluster headaches, new daily persistent headache (NDPH), and chronic post-traumatic headache (PTH), however evidence, particularly for NDPH and PTH treatment, is currently lacking for both adults and children.

“Pediatric and adolescent trials of anti-CGRP [monoclonal antibodies] should be designed to maximize the chances of determining efficacy in these age groups, and should focus on those who have not been successful with current multidisciplinary care,” write the authors. They add that “In the interim, the use of anti-CGRP mAbs for the treatment of headache disorders in children and adolescents may be considered in appropriate cases, but should be done with close follow-up and attention to patient characteristics such as age, pubertal state, and medical comorbidities.”

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