Table 4.
Summary of findings for monoclonal antibodies targeting the CGRP pathway for the prevention of episodic migraine
| 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 – 3.2 days | Mean 0.7 days fewer (1.3 fewer to 0.1 fewer) | 443 (1 RCT) |
⨁⨁⨁○ Moderatea |
Eptinezumab likely results in a reduction in monthly migraine days. | |
| > 50% responder rate | 37.4 per 100 |
49.8 per 100 (40.9 to 60.0) |
443 (1 RCT) |
⨁⨁⨁○ Moderatea |
Eptinezumab likely results in an increase in > 50% responder rate. | |
| Days with acute medication use | n.a | n.a | – | – | – | – |
| Eptinezumab 300 mg quarterly | ||||||
| Monthly migraine days | The mean monthly migraine days was −3.2 days | Mean 1.1 days fewer (1.7 fewer to 0.5 fewer) | 444 (1 RCT) |
⨁⨁⨁○ Moderatea |
Eptinezumab likely results in a slight reduction in monthly migraine days. | |
| > 50% responder rate | 37.4 per 100 |
56.3 per 100 (46.9 to 67.1) |
0.19 (0.10 to 0.28) | 444 (1 RCT) |
⨁⨁⨁○ Moderatea |
Eptinezumab likely results in an increase in > 50% responder rate. |
| Days with acute medication use | n.a | n.a | – | – | – | – |
| Erenumab 70 mg monthly | ||||||
| Monthly migraine days | The mean monthly migraine days was −1.5 days | Mean 1.4 days fewer (1.7 fewer to 1.1 fewer) | 2501 (6 RCTs) |
⨁⨁⨁⨁ High |
Erenumab likely results in a reduction in monthly migraine days. | |
| > 50% responder rate | 30.5 per 100 | 44.4 per 100 (40.7 to 48.4) | 0.14 (0.10 to 0.18) | 2371 (5 RCTs) |
⨁⨁⨁⨁ High |
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 −0.3 | Mean 0.9 fewer (1.1 fewer to 0.7 fewer) | 2128 (4 RCTs) |
⨁⨁⨁⨁ High |
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 −1.1 days | Mean 1.8 days fewer (2.2 fewer to 1.4 fewer) | 1653 (4 RCTs) |
⨁⨁⨁⨁ High |
Erenumab likely results in a reduction in monthly migraine days. | |
| > 50% responder rate | 28.6 per 100 | 47.0 per 100 (42.3 to 52.0) | 0.20 (0.16 to 0.25) | 1698 (4 RCTs) |
⨁⨁⨁⨁ High |
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 0 | Mean 1.6 fewer (1.8 fewer to 1.3 fewer) | 1693 (4 RCTs) |
⨁⨁⨁⨁ High |
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 −1.8 days | Mean 2.3 days fewer (2.8 fewer to 1.8 fewer) | 1235 (4 RCTs) |
⨁⨁⨁⨁ High |
Fremanezumab likely results in a reduction in monthly migraine days. | |
| > 50% responder rate | 25.1 per 100 | 47.6 per 100 (41.8 to 54.0) | 0.23 (0.17 to 0.28) | 999 (3 RCTs) |
⨁⨁⨁⨁ High |
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 −1.6 | Mean 1.7 fewer (2.2 fewer to 1.2 fewer) | 1013 (3 RCTs) |
⨁⨁⨁⨁ High |
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 − 1.6 days | Mean 1.9 days fewer (2.4 fewer to 1.4 fewer) | 1030 (3 RCTs) |
⨁⨁⨁⨁ High |
Fremanezumab likely results in a reduction in monthly migraine days. | |
| > 50% responder rate | 25.1 per 100 | 47.0 per 100 (41.2 to 53.4) | 0.22 (0.16 to 0.28) | 997 (3 RCTs) |
⨁⨁⨁⨁ High |
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 −1.4 | Mean 1.6 fewer (2.1 fewer to 1.1 fewer) | 811 (2 RCTs) |
⨁⨁⨁○ 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 − 1.9 days | Mean 2.1 days fewer (2.5 fewer to 1.7 fewer) | 1596 (3 RCTs) |
⨁⨁⨁⨁ High |
Galcanezumab likely results in a reduction in monthly migraine days. | |
| > 50% responder rate | 34.7 per 100 | 56.2 per 100 (50.3 to 62.7) | 0.24 (0.19 to 0.29) | 1596 (3 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 −1.7 | Mean 1.9 fewer (2.3 fewer to 1.6 fewer) | 1596 (3 RCTs) |
⨁⨁⨁⨁ High |
Galcanezumab likely results in a reduction of days with acute medication use | |
CI confidence interval, RR relative risk, n.a. not available
Explanations: aSerious risk for imprecision: only 1 study, no replication