Network Meta-analysis of Eptinezumab and Erenumab in Chronic Migraine with Medication overuse Headaches (MOH)
Arkansh Sharma1, Vinay Suresh2, Rishu Raj3, Abhigyan Datta4, Medhansh Biradar5, Allimuthu Nithyanandam6
1Government Medical College, Omandurar, Chennai, Tamil Nadu, India, 2University of Oxford, United Kingdom, 3Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India, 4University of Minnesota, USA, 5All India Institute Of Medical Sciences, Raipur, 6Department of Neurology, Tamil Nadu Government Multi-Super Speciality Hospital, Omandurar Government Estate, Chennai, India
Objective:
To compare the efficacy and safety of different doses of anti-CGRP monoclonal antibodies (Eptinezumab and Erenumab) in chronic migraine patients with medication overuse headache using a network meta-analysis.
Background:
CGRP-targeting monoclonal antibodies are effective for chronic migraine, but data on dose-specific efficacy and safety in patients with medication overuse headache (MOH) are limited.
Design/Methods:
We systematically searched PubMed, EMBASE, SCOPUS, and Web of Science through September 2025 for randomized controlled trials (RCTs) evaluating eptinezumab and erenumab in patients with chronic migraine and medication overuse headache (MOH). A frequentist network meta-analysis was conducted using the netmeta package in R with a random-effects model (DerSimonian–Laird estimator). Heterogeneity was assessed with I², and inconsistency with design-by-treatment models. Outcomes included ≥50% reduction in monthly migraine days, remission from medication overuse headache at six months, and serious adverse events. Language refinement was assisted by ChatGPT (OpenAI, GPT-5).
Results:
Three RCTs including 1,208 participants (769 active treatment, 439 placebo) were analyzed. For ≥50% reduction in monthly migraine days (3 trials, n = 1,203), eptinezumab 100 mg (OR 2.10, 95% CI 1.06–4.20), eptinezumab 300 mg (OR 2.63, 95% CI 1.09–6.32), and erenumab 140 mg (OR 3.60, 95% CI 1.45–8.91) were superior to placebo; erenumab 70 mg was not significant. For remission from medication overuse headache (2 trials, n = 1,013), both eptinezumab doses and erenumab 140 mg were effective; erenumab 70 mg was not. Serious adverse events (3 trials, n = 1,206) did not differ significantly between treatments, with no heterogeneity observed (I² = 0%).
Conclusions:
Eptinezumab (100 mg and 300 mg) and erenumab 140 mg significantly reduce monthly migraine days and aid remission from medication overuse headache, while erenumab 70 mg shows no significant benefit. All treatments were well tolerated, with no increase in serious adverse events.
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