A retrospective comparative study was conducted to compare the efficacy of monoclonal antibody drugs against the calcitonin gene-related peptide pathway in migraine and to establish whether they can be considered equivalent therapeutic alternatives for this pathology. A total of 21 patients with chronic migraine were treated with Fremanezumab 225 mg/30 days and 24 patients treated with Erenumab 70 mg/30 days for at least 6 months. Data were collected at baseline and at six months using the following scales: Headache Impact Test (HIT), Migraine Disability Assessment Scale (MIDAS), and a numerical scale of pain intensity (0 (no pain) and 10 (unbearable pain)). Days of migraine per month were recorded. Mean HIT at baseline and 6 months for Fremanezumab and Erenumab was 68.6 (62–76) and 54 (36–70) and 66 (42–78) and 53 (9–72), respectively. In both cases, it decreased by more than 6 points (efficacy criteria). Mean MIDAS at baseline and 6 months for Fremanezumab and Erenumab was 70 (25–127) and 25 (0–135) and 73.3 (19–150) and 23 (0–68), respectively. In both cases, it decreased by more than 30% (efficacy criteria). Mean pain intensity at baseline and 6 months for Fremanezumab and Erenumab was 8.8 (6–10) and 6(5–8) and 8.6 (7–10) and 6 (10–0), respectively. Mean number of migraine days in a month at baseline and 6 months for Fremanezumab and Erenumab were 16.6 (10–30) and 5.3 (0–11) days and 17 (3–30) and 5.8(–15) days, respectively. In both cases, the reduction was > 50%. It can be concluded that the initial values of the scales are very similar. The initial situation of the patient is not a trigger for the use of one drug or the other. Clinically, there is no difference between the two drugs.

Immunosuppressive therapy after liver transplantation typically combines a calcineurin inhibitor, an antimetabolite, and corticosteroids. Tacrolimus, due to its narrow therapeutic margin and variability in blood levels, requires therapeutic drug monitoring (TDM). This case report describes a 37-year-old woman with a history of bariatric surgery who developed fulminant liver failure and underwent emergency liver transplantation in January 2024. Despite receiving oral prolonged-release tacrolimus (Advagraf^®), TDM showed sustained subtherapeutic levels and elevated transaminases, leading to a type II acute rejection and re-transplantation. Given suspected tacrolimus malabsorption, a literature review suggested sublingual administration of immediate-release tacrolimus (Prograf^®) as an alternative with an initial dosing ratio of 1:2 sublingual-to-oral. The patient was switched to 3 mg/12 h sublingual tacrolimus, with subsequent dose adjustments based on TDM. Therapeutic tacrolimus levels were achieved, and transaminases gradually normalized. Sublingual tacrolimus could be an effective strategy for achieving therapeutic levels in patients with intestinal malabsorption.