Effects of Anti-Calcitonin Gene-Related Peptide for Migraines: A Systematic Review with Meta-Analysis of Randomized Clinical Trials

Abstract

We aimed to evaluate the response rate of migraines by using anti-calcitonin gene-related peptide (anti-CGRP) for patients with migraines. We searched three main medical databases up to 29 March 2019. No restriction on language and publication time were applied. Eligible trials included randomized clinical trials investigating a 50%, 75%, and 100% response rate of migraine patients after anti-CGRP intervention. The collected data were dichotomous, and risk ratios (RRs) with a 95% confidence interval (CI) were used to present the quantitative synthesis results. The systematic review identified 16 eligible randomized clinical trials (RCTs) with 9439 patients. Eight of the 16 trials with 2516 patients reported a 50% response rate, and the pooled results showed a significant benefit from anti-CGRP. However, the effects seem to gradually reduce from the first month (RR 1.99, 95% CI 1.59 to 2.49) to the third month (RR 1.48, 95% CI 1.26 to 1.75) of treatment. The magnitude of effect was influenced by the type of anti-CGRP, according to the test for differences between subgroups (I-square = 53%). The funnel plots and Egger’s tests did not show serious small study effects in the results. In conclusion, the current evidences confirmed that anti-CGRP treatment can reduce migraine pain in the short term (within three months), but the long-term effect should be investigated in the future. Moreover, its effects may be influenced by the type and dose of anti-CGRP. Therefore, future studies should make direct comparisons among anti-CGRP medications.

Optimal treatment strategy of fremanezumab in migraine prevention: a systematic review with network meta-analysis of randomized clinical trials

“…A review focusing on the use of fremanezumab in treating migraine concluded that fremanezumab exhibited higher tolerability and prophylactic effects for episodic and chronic migraine compared with other medications 15 . Furthermore, most meta-analyses have concluded that anti-CGRP antibodies are an effective and well-tolerated preventive treatment for chronic or episodic migraines 16 – 19 . However, no study has provided a robust conclusion regarding the clinical medication strategy that provides optimal efficacy.…”

Efficacy and Safety of CGRP Monoclonal Antibodies for the Prevention of Migraine Compared with Placebo: A Systematic Review and Meta-Analysis

“…In recent years, phase II and III randomized clinical trials have been completed that assessed the e cacy and safety of CGRP mAbs for chronic or episodic migraines, and full reports have been published one after another. Previous meta-analyses and systematic reviews analyzed only a small number of studies on episodic migraines [12][13][14], analyzed studies of a single CGRP monoclonal antibody [15], or only evaluated e cacy [16]. Additionally, several new studies were not included in the published meta-analyses and systematic reviews.…”

Do Treatment Strategies of Fremanezumab Have Similar Effect on Migraine?

“…The study randomly assigned patients with migraine to quarterly fremanezumab (QF), monthly fremanezumab (MF), or placebo. The authors concluded that “the early onset of efficacy of fremanezumab may have the potential to improve patient compliance and clinical outcomes.” Effects of treatment strategies of fremanezumab are still needed to be clarified because relevant studies did not further discuss how to choose treatment strategy in clinical practice …”