Different doses of galcanezumab versus placebo in patients with migraine and cluster headache: a meta-analysis of randomized controlled trials

Abstract

Background: Galcanezumab is a novel monoclonal antibody that target to calcitonin gene-related peptide (CGRP). It has been tested for the preventive treatment of migraine and episodic cluster headache by multiple randomized clinical trials (RCTs) and have been found to reduce headache frequency. Methods:We systematically searched PubMed and Embase on Cochrane Central Register of Controlled Trials (CENTRAL) from the earliest date to August 1, 2019. Relative risk (RR) and weighted mean difference (WMD) were used to evaluate clinical outcomes.Results: Seven studies were pooled with 3889 patients. Subcutaneous injection of Galcanezumab at 120 mg, 240 mg leads to a statistically significant response rate for the treatment of migraine compared with placebo (120 mg: RR = 1.51; 95% CI, 1.33 to 1.70; P < 0.001; 240 mg: RR = 1.58; 95% CI, 1.43 to 1.76; P < 0.001). Among them, 120 mg group has the same treatment efficacy with 240 mg group (50% response: RR = 1.06; 95% CI, 0.92 to 1.22; P = 0.425; 75% response: RR = 1.07; 95% CI, 0.94 to 1.23; P = 0.301; 100% response; RR = 1.06; 95% CI, 0.81 to 1.37; P = 0.682; MHD: RR = − 0.08; 95% CI, − 0.55 to − 0.40; P = 0.748) while related to a lower risk for adverse events for the treatment of migraine (120 mg RR = 1.06; 95% CI, 0.99 to 1.14; P = 0.084; 240 mg: RR = 1.17; 95% CI, 1.09 to 1.25; P < 0.001). 300 mg per month galcanezumab is effective for the prevention of episodic cluster headache measured by at least 50% reduction of cluster headache frequency at week 3 (RR = 1.36; 95% CI, 1.00-1.84; P = 0.048).Conclusions: Use of galcanezumab is related to a significantly reduced monthly headache frequency compared with placebo for the treatment of migraine and episodic cluster headache, 120 mg has the same treatment efficacy with 240 mg group while related to a lower risk for adverse effects for the treatment of migraine. 300 mg per month galcanezumab is effective for the prevention of episodic cluster headache with no significantly increased adverse events.

Safety and Efficacy of Fremanezumab for the Prevention of Migraine: A Meta-Analysis From Randomized Controlled Trials

“…The monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptor including eptinezumab, fremanezumab, galcanezumab, and erenumab are explicitly developed for the prevention of migraine. Existing research confirmed that the galcanezumab are one of the most effective and safe for migraine prevention (12,13). Moreover, erenumab and eptinezumab were also proved to be safe and effective in preventing episodic and chronic migraines (14)(15)(16).…”

Different Dosage Regimens of Eptinezumab for the Treatment of Migraine: A Meta-Analysis from Randomized Controlled Trials

“…After the analysis of our data, we found few limitations in our study which cannot be avoided through existing researches. First, numerous previous studies have concluded evidence to use other CGRP monoclonal antibodies such as ubrogepant, galcanezumab and rimegepant, for the treatment of migraine [20][21][22]. However, as interventions in our study were related to different dosage regimens of eptinezumab and placebo, we can only conclude the advantages of eptinezumab compared with placebo.…”

Galcanezumab for the Management of Migraine: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

“…Our study has several strengths. The large number of included trials is the main strength of our study when compared to previous meta-analysis studies [25][26][27]. We only included randomized placebo-controlled clinical trials to ensure high-quality evidence.…”