Efficacy and Safety of Monoclonal Antibody Against Calcitonin Gene-Related Peptide or Its Receptor for Migraine: A Systematic Review and Network Meta-analysis

Abstract

Background: The optimal monoclonal antibody against calcitonin gene-related peptide (CGRP) for adult patients with migraine has yet to be determined. Therefore, we aimed to compare the effectiveness of different monoclonal antibodies against CGRP or its receptor for adult patients with migraine through a network meta-analysis of randomized controlled trials.Methods: We systematically searched the MEDILNE, Embase, ClinicalTrials.gov, and Cochrane Library databases for relevant publications from inception until October 30, 2020. Only randomized clinical trials of adults with migraine that assessed any calcitonin gene-related peptide monoclonal antibody and reported clinical outcomes were included. The primary outcomes were changes in monthly migraine days and treatment-emergent adverse eventsResults: We initially retrieved 2,070 publications, and ultimately, 18 randomized clinical trials totaling 8,926 patients were included. In terms of efficacy, eptinezumab (MD −1.43, 95% CrI −2.59 to −0.36), erenumab (MD −1.61, 95% CrI −2.40 to −0.84), fremanezumab (MD −2.19, 95% CrI −3.15 to −1.25), and galcanezumab (MD −2.10, 95% CrI −2.76 to −1.45) significantly reduced MMDs compared with placebo. In terms of safety, only galcanezumab increased the incidences of TEAEs (RR 1.11, 95% CrI 1.01–1.22) and serious adverse events (RR 2.95, 95% CrI 1.41–6.87) compared with placebo.Conclusion: Most drugs performed similarly and were superior to placebo in most of our analyses. Further head-to-head research on different types of CGRP monoclonal antibodies is necessary to validate the present findings.

Eptinezumab: A calcitonin gene-related peptide monoclonal antibody infusion for migraine prevention

“…No head-to-head studies have been completed comparing various CGRP monoclonal antibodies. One network meta-analysis conducted by Wang et al 48 attempted to compare MMD and TEAEs for the four available monoclonal antibodies. Comparison to placebo yielded significant differences in patient MMD for each of the agents.…”

“…It is notable that these comparisons include both episodic and chronic migraine patients and each medication at various doses. 48 …”

Tratamiento preventivo de la migraña con fremanezumab subcutáneo

“…Los cuatro CGRP-MAb han mostrado eficacia en los 18 ensayos clínicos de fase III realizados (n = 8.926 pacientes), lo que les confiere «eficacia de grupo» 23 . En promedio, los CGRP-MAb reducen 1,4 DMM respecto al placebo 23 .…”

“…Los cuatro CGRP-MAb han mostrado eficacia en los 18 ensayos clínicos de fase III realizados (n = 8.926 pacientes), lo que les confiere «eficacia de grupo» 23 . En promedio, los CGRP-MAb reducen 1,4 DMM respecto al placebo 23 . Asimismo, se ha podido constatar una excelente seguridad, informándose tan solo infecciones del tracto respiratorio superior, dolor en el área de punción y estreñimiento.…”

The Safety and Efficacy of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies for the Preventive Treatment of Migraine: A Protocol for Multiple-Treatment Systematic Review and Meta-Analysis

“…However, there is no systematic review or meta-analysis with real-world data. In addition, systematic reviews and network meta-analyses have recently been conducted on randomized clinical trials (RCTs) with monthly migraine days (MMD) [26][27][28] and monthly headache days (MHD) [29] as outcomes; however, more head-to-head analyses are needed. Moreover, there are no studies comparing different effects of headache impact test (HIT-6) or monthly days with triptan use (TriD).…”