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Review
. 2024 Feb 29;22(1):23-32.
doi: 10.9758/cpn.23.1109. Epub 2023 Nov 8.

Efficacy and Safety of Anti-CGRP Monoclonal Antibodies in Prevention of Chronic Migraine: A Bayesian Network Meta-analysis

Affiliations
Review

Efficacy and Safety of Anti-CGRP Monoclonal Antibodies in Prevention of Chronic Migraine: A Bayesian Network Meta-analysis

Mundot Puliappadamb Haridas et al. Clin Psychopharmacol Neurosci. .

Abstract

Due to the unmet needs in the management of migraine, a primary headache, and disabling disorder, the past decade has focused on developing monoclonal antibodies (mAbs) against the calcitonin-gene-related peptide (CGRP) as migraine prophylactic agents. The objective of the study was to evaluate the efficacy and safety of various anti-CGRP mAbs in the prevention of chronic migraine. Network meta-analysis (NMA) was performed using the Bayesian framework to estimate the efficacy and safety of mAbs after performing a literature search in PubMed, MEDLINE, Cochrane database, and International Clinical Trial Registry Platform (ICTRP). The outcomes calculated were in terms of mean difference (MD) or odds ratio (OR) with a 95% credible interval (95%CrI). Network graphs were constructed and node-split analysis was done to analyze the inconsistency. The NMA included a total of 10 clinical trials. Galacanezumab (120 mg) (MD: -2.7; 95%CrI: -4.8 to -0.83) was found to be better than other mAbs in terms of the difference in mean migraine days (MMD). Fremanezumab quarterly dose administration showed the best response (OR: 2.9; 95%CrI: 1.9 to 4.6) in terms of responder rate. Eptinezumab was found to be safer (OR: 0.88; 95%CrI: 0.61-1.3) as compared to other mAbs in terms of the rate of adverse events. Fremanezumab (quarterly) ranked better in terms of response rate, and eptinezumab was found to be the safest in the prophylactic management of migraine. Galacenequmab was better at reducing MMD. Further studies are needed to evaluate the long-term safety, efficacy, and use of mAbs in migraine patients.

Keywords: Antibodies; Calcitonin-gene-related peptide; Migraine; Network meta-analysis; monoclonal.

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
PRISMA flowchart depicting the literature search for the included studies. PRISMA, preferred reporting items for systematic reviews and meta-analyses; NMA, network meta-analysis.
Fig. 2
Fig. 2
(A) Net graph of mean migraine days, (B) Net graph of responder rate, and (C) Net graph of adverse events. In each network graph, the size of each node is proportional to the total number of randomized participants (sample size) allocated to the corresponding treatment across all trials, and the width of each line is proportional to the total number of randomized controlled trials evaluating the corresponding treatment comparison. EP100, eptinezumab 100 mg; EP300, eptinezumab 300 mg; ER140, erenumab 140 mg; ER70, erenumab 140 mg; FM, fremanezumab (monthly); FQ, fremanezumab (quarterly); F900, fremanezumab 900 mg; PLC, placebo; G120, galcanezumab 120 mg; G240, galcanezumab 240 mg.
Fig. 3
Fig. 3
Forest plot illustrating the (A) mean difference (95% credible interval, 95%Crl) in mean migraine days of various pharmacotherapeutic management vs. placebo, (B) odds ratio (95%Crl) of the responder rate of various pharmacological management against placebo, (C) odds ratio (95%Crl) of the rate of adverse drug reactions of various drug regimens against placebo. EP100, eptinezumab 100 mg; EP300, eptinezumab 300 mg; ER140, erenumab 140 mg; ER70, erenumab 140 mg; FM, fremanezumab (monthly); FQ, fremanezumab (quarterly); F900, fremanezumab 900 mg; PLC, placebo; G120, galcanezumab 120 mg; G240, galcanezumab 240 mg.
Fig. 4
Fig. 4
SUCRA (surface under cumu-lative ranking) score with ranking for (A) difference in mean migraine days, (B) odds ratio of responder rate, and (C) odds ratio of adverse events for various pharmacotherapeutic regi-mens (the x-axis denotes treatment, and the y-axis denotes the SUCRA score).
Fig. 5
Fig. 5
A scatter plot comparing the SUCRA (surface under cumulative ranking) scores of differences in mean migraine days against the odds ratio of the adverse events of the various pharmacotherapy regimens.

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