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Headache Medicine Connections


Headache Medicine Connections

Year: 2021, Volume: 1, Issue: 2, Pages: 23-30

Review Article

Effects of Anti-CGRP monoclonal antibodies for episodic and chronic migraine on migraine characteristics, disability, impact and quality of life beyond 3 months of treatment: A Systematic review and Meta-analysis

Received Date:16 November 2021, Accepted Date:18 November 2021, Published Date:17 December 2021


Objective: At the time of this study, there were no systematic reviews to evaluate phase III RCT`s of CGRP monoclonal antibodies on migraine characteristics, migraine related disability, impact and quality of life after 3 months. This meta-analysis is aimed to systematically review available data on the effect of anti-CGRP monoclonal antibodies on migraine characteristics, migraine related disability, impact and quality of life after 3 months of treatment. Methods: A systematic literature search was performed to identify phase III randomized-controlled trials on anti-GCRP monoclonal antibodies on migraine prevention. The primary outcome was the change in migraine characteristics monthly migraine days, monthly acute migraine specific medication days and 50 % responder rate. Secondary outcome was change in patient functioning and quality of life assessed through Migraine- Specific Quality of Life Questionnaire (MSQ) Migraine Disability Assessment Questionnaire (MIDAS), Headache Impact test (HIT -6) and Migraine Physical Function Impact Diary (MPFID). We calculated the mean difference (MD), standard deviation (SD), and 95 % confidence intervals for the outcomes. Results: Four trials showed effect of anti-CGRP monoclonal antibodies on migraine characteristics and quality of life after 3 months, named EVOLVE 1, EVOLVE 2, STRIVE, HALO_LTS. These trials present data on galcanezumab (120mg, 240 mg, monthly), erenumab (70 mg, 140 mg, monthly) and fremanezumab (225 mg, 675 mg, quarterly, monthly), respectively. The trials included 4625 patients with migraine, 3515 with episodic migraine and 1110 with chronic migraine. Just three of them were included in the meta-analysis because HALO_LTS had no placebo-controlled group. In the included trials, anti-CGRP monoclonal antibodies (galcanezumab and erenumab) were superior to placebo for MMDs, 50% reduction rate, MSQ_RFR and MIDAS beyond a 3-month treatment period. Conclusion: Galcanezumab and erenumab demonstrated improvement in migraine characteristics and quality of life above and beyond those seen with placebo after 3-months of treatment in episodic migraine, providing placebo-controlled evidence. There is a need to perform good RCT`s to evaluate the efficacy of all anti-CGRP monoclonal antibodies on migraine characteristics, impact and quality of life on longer time frame (beyond 12 months) and on different migraine populations such as chronic migraine, medication overuse headache and refractory migraine.



Keywords: CGRP, Antibodies, Migraine, Disability


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© 2021 Published by World Headache Society. This is an open-access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)


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