Concerns that people treated with CGRP-targeted monoclonal antibodies for their migraine may be at risk of developing hypertension have been strengthened by new research.
A Netherlands study recruited 211 patients treated with erenumab (70-140 mg every 4 weeks) or fremanezumab (225 mg every four weeks) at the Leiden Headache Center between January 2019 and January 2021.
It found a significant and sustained increase in systolic and diastolic blood pressure (BP) at all time points – 3, 6, 9 and 12 months after starting the mAbs – compared to baseline BP.
Systolic BP rose by about 5 mmHg and diastolic BP by about 3 mmHg.
As a result, nine patients were commenced on antihypertensive drugs. Five had documented hypertension before starting anti-CGRP treatment but none were on BP drugs at baseline.
“While, fortunately, the majority of patients did not require treatment for hypertension, we did observe a modest effect on the mean BP,” the study said.
The study, published in Neurology [link here], reported that a larger estimated effect on both systolic and diastolic BP was observed with erenumab than with fremanezumab.
“This study provides Class III evidence that anti-CGRP (receptor) antibodies increase blood pressure when used to treat patients with migraine,” it said.
The investigators said studies indicated that CGRP provides a key compensatory mechanism against hypertension.
“Thus, while a potential risk of hypertension may arise when patients are treated with CGRP blocking medication, it may be that blocking CGRP is only potentially problematic for patients already at risk of developing hypertension,” it said.
It noted that BP rises were apparent in the first weeks after the initial erenumab injection.
“This suggests that whether a patient develops hypertension, will be apparent soon after initiating treatment. At the same time, it seems that the rise in BP is a long lasting effect of treatment and no adaptation process takes place within at least 12 months.”