Efficacy of Calcitonin Gene-Related Peptide Antagonists in the Treatment of Acute Migraine: A Systematic Review and Meta-analysis

Objective. This study determined the efficacy of calcitonin gene-related peptide (CGRP) antagonists in the treatment of acute migraine. Methods. Seven randomized, controlled trials were included. Outcome measures used were pain freedom and pain relief two hours after treatment. Results. The difference in pain freedom 2 hours post-dose significantly favored gepants 140/150 mg (OR=2.39, 95% CI=1.93-2.96, P<0.00001) and 280/300 mg (OR=2.94, 95% CI=2.44-3.35, P<0.00001) over placebo, while the difference in pain freedom 2 hours post- dose did not significantly favor triptans over gepants 140/150 mg and vice versa (OR=0.62, 95% CI=0.32-1.21, P=0.16) and over gepants 280/300 mg (OR=0.86, 95% CI=0.64-1.15, P=0.34). The difference in pain relief 2 hours post-dose significantly favored gepants 140/150 mg (OR=2.49, 95% CI=2.13-2.91, P<0.00001) and 280/300 mg (OR=2.78, 95% CI=2.41-3.21, P<0.00001) over placebo. The difference in pain relief 2 hours post-dose significantly favored triptans over gepants 140/150 mg (OR=0.73, 95% CI=0.56-0.96, P=0.03), but not over gepants 280/300 mg and vice versa (OR=0.98, 95% CI=0.76-1.27, P=0.89). Conclusion. With regard to pain freedom and pain relief two hours post-dose, CGRP antagonists are more efficacious than placebo in the treatment of acute migraine but there is insufficient evidence to demonstrate superior efficacy of CGRP antagonists over triptans.