Abstract
BackgroundMigraine is one of the most common neurological disorders that leads to disabilities. However, the conventional drug therapy for migraine might be unsatisfactory at times. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of calcitonin-gene-related peptide binding monoclonal antibody (CGRP mAb) for the preventive treatment of episodic migraine, and provide high-quality clinical evidence for migraine therapy.MethodsA systematic electronic database search was conducted to identify the potentially relevant studies. Two independent authors performed data extraction and quality appraisal. Mean difference (MD) and risk ratio (RR) were pooled for continuous and dichotomous data, respectively. The significance levels, weighted effect sizes and homogeneity of variance were calculated.ResultsEleven high-quality randomized control trials that collectively included 4402 patients were included in this meta-analysis. Compared to placebo group, CGRP mAb therapy resulted in a reduction of monthly migraine days [weighted mean difference (WMD) = − 1.44, 95% CI = (− 1.68,− 1.19)] and acute migraine-specific medication days [WMD = − 1.28, 95% CI = (− 1.66,− 0.90)], with an improvement in 50% responder rate [RR = 1.51, 95% CI = (1.37,1.66)]. In addition, the adverse events (AEs) and treatment withdrawal rates due to AEs were not significantly different between CGRP mAb and placebo groups. Similar efficacy and safety results were obtained for erenumab, fremanezumab, and galcanezumab in subgroup analysis.ConclusionsThe current body of evidence reveals that CGRP mAb is an effective and safe preventive treatment for episodic migraine.
Highlights
Migraine is one of the most common neurological disorders that leads to disabilities
Study selection Studies were included in this meta-analysis if they met the following criteria. (i) Randomized, double-blinded, placebo-controlled, parallel-group studies with experimental and control groups receiving Calcitonin gene-related peptide (CGRP) Calcitonin-gene-related peptide binding monoclonal antibody (mAb) and matched placebo, respectively. (ii) Adults aged ≥18 years, regardless of gender or ethnicity. (iii) Subjects diagnosed with episodic migraine according to the International Classification of Headache Disorders III (ICHD-III) for at least 1 year prior to enrollment [19]. (iv) Studies reported at least one of the following outcomes: the decreased number of monthly migraine days, ≥ 50% reduction from baseline in the mean number of migraine days per month, monthly acute migraine-specific medication prescribed from baseline to endpoint, and adverse events (AEs)
No obvious asymmetry was identified in the funnel plot, indicating that there was no publication bias. In this meta-analysis of 11 high-quality studies involving a total of 4402 episodic migraineurs, we found that CGRP mAbs could reduce the numbers of monthly migraine days and acute migraine-specific medication days, as well as improve the 50% responder rate, as compared to placebo group
Summary
Migraine is one of the most common neurological disorders that leads to disabilities. The conventional drug therapy for migraine might be unsatisfactory at times. This meta-analysis aimed to evaluate the efficacy and safety of calcitonin-gene-related peptide binding monoclonal antibody (CGRP mAb) for the preventive treatment of episodic migraine, and provide high-quality clinical evidence for migraine therapy. Deng et al BMC Neurology (2020) 20:57 only based on rules of thumb or expert opinions [9,10,11] It may depend on a number of factors, including attack frequency and severity, responsiveness to medications for acute migraine, and coexisting conditions [9]. Due to the lack of efficacy and intolerable side effects of available conventional preventive therapies, the management of patients with migraine might be unsatisfactory sometimes. Novel effective drugs with good tolerability, few side effects and high retention rates are needed for episodic migraineurs
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