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Review
. 2023 Jul;12(7):e230021.
doi: 10.57264/cer-2023-0021. Epub 2023 May 24.

Comparison of indirect treatment methods in migraine prevention to address differences in mode of administration

Christopher G Fawsitt  1 , Howard Thom  1   2 , Stephane A Regnier  3 , Xin Ying Lee  3 , Steven Kymes  3 , Lene Vase  4
Affiliations
Review

Comparison of indirect treatment methods in migraine prevention to address differences in mode of administration

Christopher G Fawsitt et al. J Comp Eff Res. 2023 Jul.

Abstract

Aim: Indirect treatment comparisons (ITCs) are anchored on a placebo comparator, and the placebo response may vary according to drug administration route. Migraine preventive treatment studies were used to evaluate ITCs and determine whether mode of administration influences placebo response and the overall study findings. Materials & methods: Change from baseline in monthly migraine days produced by monoclonal antibody treatments (subcutaneous, intravenous) was compared using fixed-effects Bayesian network meta-analysis (NMA), network meta-regression (NMR), and unanchored simulated treatment comparison (STC). Results: NMA and NMR provide mixed, rarely differentiated results between treatments, whereas unanchored STC strongly favors eptinezumab over other preventive treatments. Conclusion: Further investigations are needed to determine which ITC best reflects the impact of mode of administration on placebo.

Keywords: indirect treatment comparisons; intravenous; migraine; mode of administration; network meta-analysis; network meta-regression; placebo response; subcutaneous; unanchored simulated treatment comparison.

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Conflict of interest statement

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.. Forest plots of mean difference in change from baseline in monthly migraine days at 12 weeks for all treatments against eptinezumab, calculated using fixed effects network meta-analysis.
(A) difference versus eptinezumab 100 mg in episodic migraine (EM), (B) difference versus eptinezumab 300 mg in EM, (C) difference versus eptinezumab 100 mg in chronic migraine (CM), (D) difference versus eptinezumab 300 mg in CM. Data are shown as mean difference (95% Bayesian credible interval; one-sided Bayesian p-value). Values <0 favor eptinezumab 100 mg (panels A and C) or eptinezumab 300 mg (panels B and D).
Figure 2.
Figure 2.. Forest plots of mean difference in change from baseline in monthly migraine days at 12 weeks for all treatments against eptinezumab, calculated using fixed effects network meta-regression.
(A) Difference versus eptinezumab 100 mg in episodic migraine (EM), (B) difference versus eptinezumab 300 mg in EM, (C) difference versus eptinezumab 100 mg in chronic migraine (CM), (D) difference versus eptinezumab 300 mg in CM. Data are shown as mean difference (95% Bayesian credible interval; one-sided Bayesian p-value). Values <0 favor eptinezumab 100 mg (panels A and C) or eptinezumab 300 mg (panels B and D).
Figure 3.
Figure 3.. Forest plots of mean difference in change from baseline in monthly migraine days at 12 weeks for all treatments against eptinezumab, calculated using fixed effects simulated treatment comparison.
(A) Difference versus eptinezumab 100 mg in episodic migraine (EM), (B) difference versus eptinezumab 30 mg in EM, (C) difference versus eptinezumab 100 mg in chronic migraine (CM), (D) difference versus eptinezumab 300 mg in CM.
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