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Table 6 Summary of findings for monoclonal antibodies targeting the CGRP pathway for the prevention of chronic migraine

From: European Headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention – 2022 update

Outcomes

Anticipated absolute effects (95% CI)

Relative effect (95% CI)

№ of participants (studies)

Certainty of the evidence (GRADE)

Comments

Risk with placebo

Risk with active durg

Eptinezumab 100 mg quarterly

 Monthly migraine days

The mean monthly migraine days was −5.6 days

Mean 2.1 days fewer (2.9 fewer to 1.3 fewer)

 

956 (2 RCTs)

High

Eptinezumab likely results in a reduction in monthly migraine days.

 > 50% responder rate

39.6 per 100

57.0 per 100 (50.4 to 64.2)

0.17 (0.11 to 0.24)

956 (2 RCTs)

High

Eptinezumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −1.9

Mean 1.2 days fewer (1.7 fewer to 0.6 fewer)

 

722 (1 RCT)

Moderatea

Eptinezumab likely results in a reduction of days with acute medication use

Eptinezumab 300 mg quarterly

 Monthly migraine days

The mean monthly migraine days was – 5.6 days

Mean 2.6 days fewer (3.3 fewer to 1.9 fewer)

 

946 (2 RCTs)

High

Eptinezumab likely results in a slight reduction in monthly migraine days.

 > 50% responder rate

39.6 per 100

60.3 per 100 (53.5 to 67.8)

0.21 (0.15 to 0.27)

946 (2 RCTs)

High

Eptinezumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −1.9

Mean 1.4 days fewer (1.9 fewer to 0.9 fewer)

 

716 (1 RCT)

Moderatea

Eptinezumab likely results in a reduction of days with acute medication use

Erenumab 70 mg monthly

 Monthly migraine days

The mean monthly migraine days was −4.0 days

Mean 2.2 days fewer (3.1 fewer to 1.2 fewer)

 

571 (2 RCTs)

High

Erenumab likely results in a reduction in monthly migraine days.

 > 50% responder rate

23.0 per 100

40.0 per 100 (31.4 to 50.0)

0.16 (0.08 to 0.25)

469 (1 RCT)

Moderatea

Erenumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −1.6

Mean 1.9 fewer (2.6 fewer to 1.1 fewer)

 

469 (1 RCT)

Moderatea

Erenumab likely results in a reduction of days with acute medication use

Erenumab 140 mg monthly

 Monthly migraine days

The mean monthly migraine days was −4.2 days

Mean 2.5 days fewer (3.5 fewer to 1.4 fewer)

 

468 (1 RCT)

Moderatea

Erenumab likely results in a reduction in monthly migraine days.

 > 50% responder rate

23.0 per 100

41.0 per 100 (32.5 to 51.5)

0.18 (0.09 to 0.26)

468 (1 RCT)

Moderatea

Erenumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −1.6

Mean 2.6 fewer (3.3 fewer to 1.8 fewer)

 

468 (1 RCT)

Moderatea

Erenumab likely results in a reduction of days with acute medication use

Fremanezumab 225 mg monthly

 Monthly migraine days

The mean monthly migraine days was −2.2 days

Mean 2.6 days fewer (3.3 fewer to 2.0 fewer)

 

1463 (4 RCTs)

Moderateb

Fremanezumab likely results in a reduction in monthly migraine days.

 > 50% responder rate

18.4 per 100

39.0 per 100 (34.4 to 44.2)

0.20 (0.16 to 0.25)

1298 (3 RCTs)

Moderateb

Fremanezumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −2.1

Mean 1.9 fewer (2.6 fewer to 1.3 fewer)

 

1123 (2 RCT)

Lowa,b

Fremanezumab likely results in a reduction of days with acute medication use

Fremanezumab 675 mg quarterly

 Monthly migraine days

The mean monthly migraine days was −2.2 days

Mean 2.2 days fewer (2.9 fewer to 1.5 fewer)

 

1461 (3 RCTs)

High

Fremanezumab likely results in a reduction in monthly migraine days.

 > 50% responder rate

16.4 per 100

34.8 per 100 (30.1 to 40.0)

0.18 (0.13 to 0.23)

1125 (2 RCTs)

Moderatea

Fremanezumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −2.1

Mean 1.7 fewer (2.4 fewer to 1.0 fewer)

 

1125 (2 RCT)

Moderatea

Fremanezumab likely results in a reduction of days with acute medication use

Galcanezumab 120 mg monthly (240 mg loading dose)

 Monthly migraine days

The mean monthly migraine days was −2.5 days

Mean 2.6 days fewer (3.5 fewer to 1.6 fewer)

 

1004 (2 RCTs)

High

Galcanezumab likely results in a reduction in monthly migraine days.

 > 50% responder rate

14.4 per 100

28.5 per 100 (23.3 to 34.5)

0.15 (0.09 to 0.20)

1004 (2 RCTs)

High

Galcanezumab likely results in an increase in > 50% responder rate.

 Days with acute medication use

The mean reduction in days with acute medication use was −2.1

Mean 2.8 fewer (3.7 fewer to 2.0 fewer)

 

1004 (2 RCTs)

High

Galcanezumab likely results in a reduction of days with acute medication use

  1. CI confidence interval, RR relative risk, n.a. not available
  2. Explanations: aSerious risk for imprecision: only 1 study, no replication; bSerious risk for indirectness: 675 mg loading dose in RCTs