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Related Experiment Video

Updated: Jun 20, 2025

Author Spotlight: Deciphering Electrical Networks Behind Complex Brain Activities and Disorders
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A Risk-Difference Meta-Analysis for the Prophylactic Treatments of Chronic Migraine.

Michalis Kodounis1,2, Theodoros S Constantinidis3, Konstantina Rizonaki2,4

  • 1First Neurology Department, Eginitio Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, GRC.

Cureus
|July 18, 2024
PubMed
Summary

New monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) show comparable efficacy and safety to standard treatments for chronic migraine (CM). These CGRP mAbs offer a promising, migraine-specific prophylactic option with similar treatment benefits.

Keywords:
absolute risk differenceanti-calcitonin gene-related peptide (cgrp) monoclonal antibodieschronic migraine (cm)meta-analysisonabotulinumtoxinatopiramate

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Area of Science:

  • Neurology
  • Pharmacology
  • Clinical Trials

Background:

  • Chronic migraine (CM) presents a substantial global health burden, with limited specific prophylactic treatments available historically.
  • Monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) have emerged as a novel, targeted prophylactic therapy for migraine.
  • Existing CGRP mAbs (erenumab, fremanezumab, galcanezumab, eptinezumab) lack direct head-to-head comparisons with established anti-migraine treatments.

Purpose of the Study:

  • To indirectly compare the efficacy and safety of anti-CGRP mAbs against standard CM prophylactic treatments.
  • To utilize a cross-trial indirect model based on absolute risk difference (ARD) to calculate Number Needed to Treat (NNT) and Number Needed to Harm (NNH).

Main Methods:

  • A systematic search of Phase 3 and 2b randomized controlled trials (RCTs) for CM prophylaxis was conducted in MEDLINE and CENTRAL databases.
  • Inclusion and exclusion criteria were applied to select eligible RCTs.
  • ARD for the 50% responder rate (reduction in monthly migraine days), adverse events (AEs), serious adverse events (SAEs), and withdrawals were calculated to determine NNT and NNH.

Main Results:

  • Eight RCTs were included in the analysis. Anti-CGRP mAbs demonstrated statistically significant efficacy with similar NNTs (ranging from 5 to 8).
  • OnabotulinumtoxinA (oBTA) showed non-significant ARD with a higher NNT (56).
  • Topiramate yielded contradictory results across studies, with NNTs of 2 and 22, respectively. Efficacy and safety profiles of CGRP mAbs were comparable to standard treatments.

Conclusions:

  • All four investigated anti-CGRP mAbs exhibit consistently high efficacy for CM prophylaxis, comparable to standard treatments.
  • The findings suggest CGRP mAbs are a valuable and effective option for CM management, offering similar benefits to existing therapies.
  • Further head-to-head trials are warranted to definitively establish relative efficacy and safety profiles.