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.
Highlights
Migraine is a debilitating neurological disease and is regarded as one of the most common global causes of disease-related disability (Gaul et al, 2011; Messali et al, 2016; MacGregor, 2017)
18 studies were included in the systematic review with network meta-analysis (Bigal et al, 2015; Goadsby et al, 2017; Sun et al, 2016; Silberstein et al, 2017; Tepper et al, 2017; Detke et al, 2018; Dodick et al, 2018a; Dodick et al, 2018b; Skljarevski et al, 2018a; Skljarevski et al, 2018b; Stauffer et al, 2018; Dodick et al, 2019; Ferrari et al, 2019; Sakai et al, 2019; Ashina et al, 2020; Lipton et al, 2020; Mulleners et al, 2020; NCT02959177, 2020)
Our analysis demonstrated that fremanezumab was superior to eptinezumab (RR 1.65, 95% CrI 1.00–2.75) in reducing the frequency of headache attacks by at least 50%
Summary
Migraine is a debilitating neurological disease and is regarded as one of the most common global causes of disease-related disability (Gaul et al, 2011; Messali et al, 2016; MacGregor, 2017). Due to the lack of efficacy and intolerability of these suboptimal drugs, migraine patients often switch, reinitiate, or discontinue ongoing treatments. It has been reported that approximately 68% of migraine patients discontinued preventive treatment within 6 months due to poor tolerability or insufficient benefit (Ford et al, 2017; González-Hernández et al, 2018). Novel treatments with improved efficacy and tolerability are warranted to offer new opportunities for this group of patients. The optimal monoclonal antibody against calcitonin gene-related peptide (CGRP) for adult patients with migraine has yet to be determined. 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
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