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. 2021 Mar 25:12:649143.
doi: 10.3389/fphar.2021.649143. eCollection 2021.

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

Xing Wang  1 , Yuqi Chen  1 , Jinlei Song  1 , Chao You  1   2
Affiliations

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

Xing Wang et al. Front Pharmacol. .

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 events Results: 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.

Keywords: calcitonin gene-related peptide; headache; meta-analysis; migraine; monoclonal antibody.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram showing the process of study selection. RCT: Randomized controlled trials.
FIGURE 2
FIGURE 2
Network plot of (A) change in monthly migraine days (B) treatment-emerging adverse events (C) 50% response rates (D) 75% response rates (E) serious adverse events. The width of the lines is proportional to the number of studies comparing every pair of treatments, and the size of each circle is proportional to the number of participants. Ep: eptinezumab; Er: erenumab; (F): fremanezumab; (G): galcanezumab.
FIGURE 3
FIGURE 3
(A). Network meta-analysis of change in monthly migraine days. (B). Ranking positions of different drugs in monthly migraine days. CrI: credible interval.
FIGURE 4
FIGURE 4
(A). Network meta-analysis of treatment-emerging adverse events. (B). Ranking positions of different drugs in treatment-emerging adverse events. CrI: credible interval.
See this image and copyright information in PMC

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