Efficacy of CGRP Inhibitors in Preventive Pharmacotherapy for Migraine—A Network Meta-analysis and Systematic Review
Aman Bhonsale1, Vinay Suresh2, Muhammad Aaqib Shamim3, Malavika Rudrakumar4, Venkata Vamshi Krish Dondapati5, Hariharan Seshadri6, Bishal Dhakal7, Poorvikha S8, Dilip Suresh9, Priyanka Roy10, Mainak Bardhan11
1All India Institute of Medical Sciences, Nagpur, 2King George's Medical University, 3Department of Pharmacology, All India Institute of Medical Science - Jodhpur, 4St. John's medical college, 5Institute of Medical Sciences, Banaras Hindu University, 6Madras Medical College, 7Nepalese Army Institute of Health Sciences, 8St John’s Medical College, Bangalore, India, 9Madras Medical College, Chennai, Tamil Nadu, India, 10Directorate of Factories,Department of Labour Government of West Bengal, India, 11Neuro Medical Oncology, Miami Cancer Institute,Baptist Health South Florida, USA
Objective:

To assess the efficacy of CGRP inhibitors in migraine prevention by conducting a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Background:

Calcitonin Gene-Related Peptide (CGRP) inhibitors have emerged as a promising approach in migraine prevention, reducing the frequency of migraine attacks while avoiding the typical side effects associated with other medications. Nevertheless, a comprehensive review of the efficacy of CGRP inhibitors as preventive pharmacotherapy is still warranted.



Design/Methods:

A systematic search was conducted in the PubMed/Medline, EMBASE, clinicaltrials.gov, and Cochrane databases to identify relevant RCTs involving CGRP inhibitors in migraine prevention. A pairwise meta-analysis and network meta-analysis (NMA) were conducted using the frequentist approach, to obtain both direct and indirect comparisons of each measure, as risk ratios (RR) and mean differences (MD)

Results:

A total of four RCTs, with a pooled population of 1690 migraine patients were included for analysis. Among these trials, two had participants with Episodic Migraine, one with Chronic Migraine, and one included both the populations. Atogepant (RR, 2.06; 95% CI, 1.55 to 2.72) and Rimegepant (RR, 1.18; 95% CI, 0.77 to 1.83) were more effective than placebo in 50% reduction of pain, with Atogepant being more effective than Rimegepant, as shown by the network estimate (RR, 1.74; 95% CI, 1.04 to 2.91). The mean difference from placebo in the change from baseline in monthly migraine days (MMD) were -1.96 days with Atogepant (95% CI, -2.90 to -1.01) and -0.80 days with Rimegepant (95% CI, -2.27 to 0.67) with network estimate showing Atogepant (MD, -1.16; 95% CI, -2.91 to 0.59) as more effective in reducing the number of monthly migraine days than Rimegepant, but was not statistically significant. The ranking probabilities ranked Atogepant as a superior option, followed by Rimegepant

Conclusions:

Atogepant and Rimegepant both exhibit prophylactic efficacy in achieving significant reduction in migraine-related pain, with Atogepant showing superior efficacy.

10.1212/WNL.0000000000206369