Calcitonin gene-related peptide (CGRP) receptor antagonists, commonly known as gepants, are a class of drugs that act as antagonists of the calcitonin gene-related peptide receptor (CGRPR). [1]
Several monoclonal antibodies that bind to the CGRP receptor or peptide have been approved for prevention of migraine. [2] Nerve activation triggers the release of CGRP and other neuropeptides, leading to inflammation, pain, and swelling. Three small molecule CGRPR antagonists are approved in the U.S. as antimigraine agents. [3] [4] [5] Drugs of this class have also been investigated for use in osteoarthritis. [6]
A study has found botox effective against necrotizing fasciitis caused by S. pyogenes in mice. [20] Its mechanism of action is by blocking CGRP receptor of nerve cells, which trigger intense pain and activate CGRP cascade, which prevents the immune system attacks to control the pathogen. [21] Botox blocks the CGRP cascade of nerve cells. [22]
As of 2018, erenumab, brand name Aimovig, was approved in the U.S. for use for migraines. It interacts by blocking the CGRP receptor. [23] As of 2018, fremanezumab, brand name Ajovy, was approved in the U.S. for use for migraines. It interacts with the CGRP protein expressed during an attack. [24] The third approved treatment, as of 2018, galcanezumab, brand name Emgality, was approved in the U.S. for use in migraines. It also interacts with the protein. [25]
As of February 2020, eptinezumab (Vyepti) was approved by the FDA for the treatment of migraine via intravenous infusion as well. [26]
Three small-molecule antagonists have been approved for treatment of migraine: ubrogepant, rimegepant, and atogepant. [4] [3] [5] Ubrogepant and rimegepant are approved for acute treatment. [4] [3] Atogepant and rimegepant are approved for preventative treatment. [5] [3]