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https://doi.org/10.20471/acc.2024.63.02.22

Croatian guidelines for specific preventive treatment of migraine with monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) (eptinezumab, fremanezumab, and galcanezumab) or the CGRP receptor (erenumab)

Davor Jančuljak ; Department of Neurology, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia *
Damir Petravić ; Department of Neurology, Zagreb University Hospital Center, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Darija Mahović Lakušić ; Department of Neurology, Zagreb University Hospital Center, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Arijana Lovrenčić-Huzjan ; School of Medicine, University of Zagreb, Zagreb, Croatia; Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia; Reference Center for Headaches, Ministry of Health of the Republic of Croatia, Zagreb, Croatia
Koraljka Bačić Baronica ; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
Marijana Bosnar Puretić ; Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; Reference Center for Headaches, Ministry of Health of the Republic of Croatia, Zagreb, Croatia; School of Medicine, Croatian Catholic University, Zagreb, Croatia; Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
Zlatko Hucika ; Department of Neurology, Zabok General Hospital and Hospital for Croatian Veterans, Zabok, Croatia
Marina Titlić ; Department of Neurology, Split University Hospital Center, Split, Croatia; School of Medicine, University of Split, Split, Croatia
Zvonimir Popović ; Department of Neurology, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Zoran Tomić ; Department of Neurology, Rijeka University Hospital Center, Rijeka, Croatia; School of Medicine, University of Rijeka, Rijeka, Croatia
Maristela Stojić ; Department of Neurology, Dubrava University Hospital, Zagreb, Croatia
Vanja Bašić Kes ; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia; Reference Center for Headaches, Ministry of Health of the Republic of Croatia, Zagreb, Croatia

* Corresponding author.

Abstract

Calcitonin gene-related peptide (CGRP) plays a key role in the pathophysiology of
migraine, acting on CGRP receptors in the trigeminovascular system, causing neurogenic inflammation
and vasodilation, and promoting nociception. Four specific monoclonal antibodies targeting CGRP
are available for prevention of episodic and chronic migraine in adults with at least four migraine
days per month. The aim of these guidelines is to provide evidence-based recommendations for the
use of monoclonal antibodies targeting CGRP in migraine prevention in Croatia. The questions were
formulated using the Patients, Intervention, Comparison, Outcome (PICO) criteria, with evidencebased
answers. To assess the quality of scientific evidence, a review of the literature available in PubMed
was performed. Relevant studies were reviewed by the Expert Group of the Headache Section of
the Croatian Neurological Society, and served as the basis for formulating the recommendations
outlined in these guidelines. We found high quality evidence for good safety and efficacy of anti-
CGRP monoclonal antibodies in the preventive treatment of episodic and chronic migraine. These
medications may be considered as first-line prophylactic therapy depending on the patient’s history,
concomitant diseases, and disease burden. Further real-world studies are needed to elucidate other
aspects of their application.

Keywords

Migraine - Prevention,Treatment; Calcitonin gene-related peptide (CGRP); Monoclonal antibody; Guidelines; Eptinezumab, Fremanezumab, Galcanezumab, Erenumab

Hrčak ID:

328166

URI

https://hrcak.srce.hr/328166

Publication date:

31.10.2025.

Article data in other languages: croatian

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