Monoclonal antibodies as a preventive therapy for migraine: A meta-analysis

Calcitonin gene-related peptide (CGRP) antagonists have recently grabbed the attention of clinicians for migraine prophylaxis. The present meta-analysis aimed to assess the efficacy and safety of CGRP monoclonal antibodies (mAbs) in patients with chronic and episodic migraine using a systematic therapeutic regimen. More specifically, double-blind placebo-controlled randomized clinical trials (RCTs) which assessed the therapeutic potential of monthly subcutaneous injections were included. The primary outcomes entailed changes in monthly migraine days (MMDs) and treatment-related adverse events (TRAEs) for: Erenumab 70 mg, fremanezumab 225 mg, and galcanezumab 120 mg. No eligible studies have investigated eptinezumab. A total of 13 RCTs were eligible (6979 patients, 84.81% females, 42.94% received active medications). Compared to placebo, the selected doses of mAbs reduced the MMDs significantly after four weeks (mean difference [MD]-2.07, 95% CI -2.47 to -1.66, P < 0.001), eight weeks (MD -1.78, 95% CI -2.26-1.49, P < 0.001), and 12 weeks (-1.80, 95% CI -2.16 to -1.43, P < 0.001). These effects remained significant with each individual medication across all treatment cycles. In addition, the number of days using acute migraine medications decreased and the proportion of 50% responders increased significantly with mAbs use compared to placebo. No significant differences between groups were noted in TRAEs. CGRP mAbs provide highly efficacious and safe outcomes which start early after the first injection. The tolerability of these medications surpasses that of other small molecule CGRP antagonists.