Clinical Psychopharmacology and Neuroscience  
Efficacy and Safety of Anti-CGRP Monoclonal Antibodies in Prevention of Chronic Migraine: A Bayesian Network Meta-analysis
Mundot Puliappadamb Haridas, Amruta Tripathy, Rituparna Maiti, Anand Srinivasan
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
Correspondence to: Anand Srinivasan
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019, India
E-mail: anandsrinivasan@aiimsbhubaneswar.edu.in
ORCID: https://orcid.org/0000-0002-0663-0922
Received: June 29, 2023; Revised: August 9, 2023; Accepted: August 13, 2023; Published online: November 8, 2023.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Due to the unmet needs in the management of migraine, a primary headache, and disabling disorder, the past decade has focused on developing monoclonal antibodies (mAbs) against the calcitonin-gene-related peptide (CGRP) as migraine prophylactic agents. The objective of the study was to evaluate the efficacy and safety of various anti-CGRP mAbs in the prevention of chronic migraine. Network meta-analysis (NMA) was performed using the Bayesian framework to estimate the efficacy and safety of mAbs after performing a literature search in PubMed, MEDLINE, Cochrane database, and International Clinical Trial Registry Platform (ICTRP). The outcomes calculated were in terms of mean difference (MD) or odds ratio (OR) with a 95% credible interval (95%CrI). Network graphs were constructed and node-split analysis was done to analyze the inconsistency. The NMA included a total of 10 clinical trials. Galacanezumab (120 mg) (MD: −2.7; 95%CrI: −4.8 to −0.83) was found to be better than other mAbs in terms of the difference in mean migraine days (MMD). Fremanezumab quarterly dose administration showed the best response (OR: 2.9; 95%CrI: 1.9 to 4.6) in terms of responder rate. Eptinezumab was found to be safer (OR: 0.88; 95%CrI: 0.61 to 1.3) as compared to other mAbs in terms of the rate of adverse events. Fremanezumab (quarterly) ranked better in terms of response rate, and eptinezumab was found to be the safest in the prophylactic management of migraine. Galacenequmab was better at reducing MMD. Further studies are needed to evaluate the long-term safety, efficacy, and use of mAbs in migraine patients.
Keywords: Migraine; Calcitonin-gene-related peptide; Antibodies, monoclonal; Network meta-analysis

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