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Nonspecific oral medications versus anti–calcitonin gene‐related peptide monoclonal antibodies for migraine: A systematic review and meta‐analysis of randomized controlled trials.

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Title: Nonspecific oral medications versus anti–calcitonin gene‐related peptide monoclonal antibodies for migraine: A systematic review and meta‐analysis of randomized controlled trials.
Authors: Robblee, Jennifer, Hakim, Sameh M., Reynolds, John M., Monteith, Teshamae S., Zhang, Niushen, Barad, Meredith
Source: Headache: The Journal of Head & Face Pain. May2024, Vol. 64 Issue 5, p547-572. 26p.
Subjects: Therapeutic use of monoclonal antibodies, Medical information storage & retrieval systems, Effect sizes (Statistics), Grey literature, Topiramate, Health insurance reimbursement, Research funding, Headache, Calcitonin, Oral drug administration, Treatment effectiveness, Meta-analysis, Genes, Peptides, Systematic reviews, MEDLINE, Medical databases, Valproic acid, Comparative studies, Migraine, Psychology information storage & retrieval systems, Sequence analysis, Evaluation, Chemical inhibitors
Geographic Terms: United States
Abstract: Objective: To compare calcitonin gene–related peptide monoclonal antibodies (CGRP mAbs) versus nonspecific oral migraine preventives (NOEPs). Background: Insurers mandate step therapy with NOEPs before approving CGRP mAbs. Methods: Databases were searched for class I or II randomized controlled trials (RCTs) comparing CGRP mAbs or NOEPs versus placebo for migraine prevention in adults. The primary outcome measure was monthly migraine days (MMD) or moderate to severe headache days. Results: Twelve RCTs for CGRP mAbs, 5 RCTs for topiramate, and 3 RCTs for divalproex were included in the meta‐analysis. There was high certainty that CGRP mAbs are more effective than placebo, with weighted mean difference (WMD; 95% confidence interval) of −1.64 (−1.99 to −1.28) MMD, which is compatible with small effect size (Cohen's d −0.25 [−0.34 to −0.16]). Certainty of evidence that topiramate or divalproex is more effective than placebo was very low and low, respectively (WMD −1.45 [−1.52 to −1.38] and −1.65 [−2.30 to −1.00], respectively; Cohen's d −1.25 [−2.47 to −0.03] and −0.48 [−0.67 to −0.29], respectively). Trial sequential analysis showed that information size was adequate and that CGRP mAbs had clear benefit versus placebo. Network meta‐analysis showed no statistically significant difference between CGRP mAbs and topiramate (WMD −0.19 [−0.56 to 0.17]) or divalproex (0.01 [−0.73 to 0.75]). No significant difference was seen between topiramate or divalproex (0.21 [−0.45 to 0.86]). Conclusions: There is high certainty that CGRP mAbs are more effective than placebo, but the effect size is small. When feasible, CGRP mAbs may be prescribed as first‐line preventives; topiramate or divalproex could be as effective but are less well tolerated. The findings of this study support the recently published 2024 position of the American Headache Society on the use of CGRP mAbs as the first‐line treatment. Plain Language Summary: Insurance companies often do not approve calcitonin gene–related peptide monoclonal antibodies (CGRP mAbs) for the treatment of migraine until patients have tried other medicines first. We reviewed and summarized data from studies that reported how well different migraine medications worked, including CGRP mAbs, and found evidence that CGRP mAbs are more effective than placebo and just as effective as other migraine drugs. This suggests that CGRP mAbs should be offered as a first‐line preventive therapy at the discretion of the clinician and the individual patient. Answer questions and earn CME credit: https://wileyhealthlearning.com/#/online‐courses/d524dd0e‐d6b3‐4fd3‐b298‐230b74599848 [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Nonspecific oral medications versus anti–calcitonin gene‐related peptide monoclonal antibodies for migraine: A systematic review and meta‐analysis of randomized controlled trials.
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  Data: <searchLink fieldCode="JN" term="%22Headache%3A+The+Journal+of+Head+%26+Face+Pain%22">Headache: The Journal of Head & Face Pain</searchLink>. May2024, Vol. 64 Issue 5, p547-572. 26p.
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Objective: To compare calcitonin gene–related peptide monoclonal antibodies (CGRP mAbs) versus nonspecific oral migraine preventives (NOEPs). Background: Insurers mandate step therapy with NOEPs before approving CGRP mAbs. Methods: Databases were searched for class I or II randomized controlled trials (RCTs) comparing CGRP mAbs or NOEPs versus placebo for migraine prevention in adults. The primary outcome measure was monthly migraine days (MMD) or moderate to severe headache days. Results: Twelve RCTs for CGRP mAbs, 5 RCTs for topiramate, and 3 RCTs for divalproex were included in the meta‐analysis. There was high certainty that CGRP mAbs are more effective than placebo, with weighted mean difference (WMD; 95% confidence interval) of −1.64 (−1.99 to −1.28) MMD, which is compatible with small effect size (Cohen's d −0.25 [−0.34 to −0.16]). Certainty of evidence that topiramate or divalproex is more effective than placebo was very low and low, respectively (WMD −1.45 [−1.52 to −1.38] and −1.65 [−2.30 to −1.00], respectively; Cohen's d −1.25 [−2.47 to −0.03] and −0.48 [−0.67 to −0.29], respectively). Trial sequential analysis showed that information size was adequate and that CGRP mAbs had clear benefit versus placebo. Network meta‐analysis showed no statistically significant difference between CGRP mAbs and topiramate (WMD −0.19 [−0.56 to 0.17]) or divalproex (0.01 [−0.73 to 0.75]). No significant difference was seen between topiramate or divalproex (0.21 [−0.45 to 0.86]). Conclusions: There is high certainty that CGRP mAbs are more effective than placebo, but the effect size is small. When feasible, CGRP mAbs may be prescribed as first‐line preventives; topiramate or divalproex could be as effective but are less well tolerated. The findings of this study support the recently published 2024 position of the American Headache Society on the use of CGRP mAbs as the first‐line treatment. Plain Language Summary: Insurance companies often do not approve calcitonin gene–related peptide monoclonal antibodies (CGRP mAbs) for the treatment of migraine until patients have tried other medicines first. We reviewed and summarized data from studies that reported how well different migraine medications worked, including CGRP mAbs, and found evidence that CGRP mAbs are more effective than placebo and just as effective as other migraine drugs. This suggests that CGRP mAbs should be offered as a first‐line preventive therapy at the discretion of the clinician and the individual patient. Answer questions and earn CME credit: https://wileyhealthlearning.com/#/online‐courses/d524dd0e‐d6b3‐4fd3‐b298‐230b74599848 [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=177244469
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        Value: 10.1111/head.14693
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      – Code: eng
        Text: English
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        PageCount: 26
        StartPage: 547
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      – SubjectFull: Therapeutic use of monoclonal antibodies
        Type: general
      – SubjectFull: Medical information storage & retrieval systems
        Type: general
      – SubjectFull: Effect sizes (Statistics)
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      – SubjectFull: Grey literature
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      – SubjectFull: Topiramate
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      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Headache
        Type: general
      – SubjectFull: Calcitonin
        Type: general
      – SubjectFull: Oral drug administration
        Type: general
      – SubjectFull: Treatment effectiveness
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      – SubjectFull: Migraine
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      – SubjectFull: United States
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      – TitleFull: Nonspecific oral medications versus anti–calcitonin gene‐related peptide monoclonal antibodies for migraine: A systematic review and meta‐analysis of randomized controlled trials.
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              Text: May2024
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