Efficacy and safety of monoclonal antibody against calcitonin gene-related peptide or its receptor for migraine patients with prior preventive treatment failure: a network meta-analysis

Abstract

Objective The relative effects of monoclonal antibody against calcitonin gene-related peptide (CGRP) or its receptor for adult migraine patients with prior treatment failure remains uncertain. Therefore, this study systematically assessed the comparative effectiveness of different CGRP binding monoclonal antibodies (mAbs) for these patients. Methods Several online databases including Ovid MEDILNE, Ovid EMBASE, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to June 15, 2022. We included randomized clinical trials (RCT) of adult migraine patients with previous treatment failure that assessed any CGRP monoclonal antibody. The primary efficacy outcome was change in monthly migraine days (MMDs), and the primary safety outcome was treatment-emergent adverse events (TEAEs). Results Overall, seven studies totaling 3, 052 patients were included. Three-node analysis showed that CGRP mAbs was superior to CGRP receptor mAbs in reducing MMDs (MD: -1.55, 95% CrI: − 2.43 to − 0.44) and improving at least 50% response rates (RR: 1.52, 95% CrI: 1.04 to 2.21). Nine-node analysis showed galcanezumab 240 mg ranked first in reducing MMDs (MD -4.40, 95% CrI − 7.60 to − 1.19) and improving 50% response rates (RR: 4.18, 95% CrI: 2.63 to 6.67). Moreover, treatment with fremanezumab or eptinezumab 300 mg provides a significant advantage over erenumab 140 mg regarding an improved response rate of at least 50%. The analysis did not show difference in incidences of TEAEs and serious adverse events in any of the comparisons. Conclusions It appears that CGRP mAbs, especially galcanezumab 240 mg, monthly fremanezumab, and eptinezumab 300 mg, seem to be the best choice for the treatment of migraine patients with previous treatment failures. This finding also calls for future research that examine the associations between these medications in migraine therapy among the same patient group to testify the present findings.

A head‐to‐head observational cohort study on the efficacy and safety of monoclonal antibodies against calcitonin gene–related peptide for chronic and episodic migraine

“…15 Recently, in the network meta-analysis of Yang et al involving 5634 patients and collecting data from 13 RCTs, pooled results showed that monthly 140 mg erenumab was the best choice to reduce the number of acute migraine-specific medication use days 18 ; however, a subsequent network meta-analysis of Wang et al, involving 3052 patients and collecting data from seven RCTs, pointed out that, conversely, anti-CGRP mAbs are superior to anti-CGRP receptor mAbs in reducing monthly migraine days. 19 Indeed, although certainly useful, meta-analyses investigating anti-CGRP mAbs often combine trials with different inclusion criteria: some focusing only on CM, some on EM, and some combining both, and thus their conclusions may be biased. For this reason, real-world evidence may provide useful evidence for the choice of the specific mAbs in certain patient subtypes.…”

Effectiveness of three calcitonin gene-related peptide monoclonal antibodies for migraine: A 12-month, single-center, observational real-world study in Japan

“…A network meta-analysis of RCTs including 3052 migraine patients showed that CGRP mAbs (galcanezumab, eptinezumab, and fremanezumab) were superior to CGRP receptor mAbs (erenumab) in reducing MMDs (36). In a real-world setting, Schiano et al (20) reported that the number of 50%-100% responders in general was similar between the CGRP mAb and CGRP-receptor mAb groups; however, !75 to 100% responders were more prevalent in patients treated with CGRP mAb (galcanezumab and fremanezumab) compared to those treated with CGRP-receptor mAb (erenumab).…”

“…A network meta-analysis of RCTs including 3052 migraine patients showed that CGRP mAbs (galcanezumab, eptinezumab, and fremanezumab) were superior to CGRP receptor mAbs (erenumab) in reducing MMDs (36). In a real-world setting, Schiano et al.…”

Neues bei Kopfschmerzen 2022–2023

“…Die Leitlinien der Deutschen Gesellschaft für Neurologie und der Deutschen Migräne-und Kopfschmerzgesellschaft geben darüber hinaus Hinweise, wie in der klinischen Praxis mit den monoklonalen Antikörpern umgegangen werden soll [9]. sprechen dann in einer Häufigkeit von 15-40% auf die alternative Antikörpertherapie an [38,39,40]. Dabei ist vor allem ein Wechsel von einem Liganden-auf einen Rezeptor-Antikörper sinnvoll oder andersherum.…”