Jae-Hwan Kwak1,2, In-Hwan Baek3,4, Dong Kyoung Ha5, Min Ji Kim5, Nayoung Han6. 1. College of Pharmacy, Kyungsung University, 309, Suyeong-ro, Nam-gu, Busan, 48434, Republic of Korea. jhkwak@ks.ac.kr. 2. Functional Food and Drug Convergence Research Center, Industry-Academic Cooperation Foundation, Kyungsung University, 309, Suyeong-ro, Nam-gu, Busan, 48434, Republic of Korea. jhkwak@ks.ac.kr. 3. College of Pharmacy, Kyungsung University, 309, Suyeong-ro, Nam-gu, Busan, 48434, Republic of Korea. baek@ks.ac.kr. 4. Functional Food and Drug Convergence Research Center, Industry-Academic Cooperation Foundation, Kyungsung University, 309, Suyeong-ro, Nam-gu, Busan, 48434, Republic of Korea. baek@ks.ac.kr. 5. College of Pharmacy, Kyungsung University, 309, Suyeong-ro, Nam-gu, Busan, 48434, Republic of Korea. 6. College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
Abstract
BACKGROUND AND OBJECTIVE: The calcitonin gene-related peptide (CGRP) is a new therapeutic target in migraine-a common disorder resulting in reduced quality of life. The aim of this study was to compare the clinical efficacy of five oral CGRP antagonists with that of a placebo and triptans against acute migraine via meta-analysis. METHODS: Suitable randomized controlled trials (RCTs) were searched in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) to compare the efficacy of oral CGRP antagonists with that of a placebo and triptans against acute migraine. Review Manager 5.4 was used for data analysis. RESULTS: A total of 17 trials met the eligibility criteria and were studied in detail. The CGRP antagonists were significantly more effective than the placebo with respect to outcomes such as pain freedom at 2 h post-dose (odds ratio = 2.11; 95% confidence intervals [CIs] = 1.90-2.35) and pain relief at 2 h post-dose (odds ratio = 1.94; 95% CIs = 1.70-2.21). Similar results were found in the subgroup analysis conducted to compare the clinical efficacy of the FDA-approved oral CGRP antagonists (ubrogepant and rimegepant) and placebo. However, the CGRP antagonists were less effective than the triptans with respect to outcomes such as pain freedom at 2 h post-dose (odds ratio = 0.66; 95% CIs = 0.55-0.78) and pain relief at 2 h post-dose (odds ratio = 0.78; 95% CIs = 0.66-0.93). CONCLUSION: CGRP antagonists are more effective than placebo against acute migraine; however, further studies are required to consider CGRP antagonists as standard first-line treatment for acute migraine instead of triptans, especially in patients with co-existing cardiovascular diseases.
BACKGROUND AND OBJECTIVE: The calcitonin gene-related peptide (CGRP) is a new therapeutic target in migraine-a common disorder resulting in reduced quality of life. The aim of this study was to compare the clinical efficacy of five oral CGRP antagonists with that of a placebo and triptans against acute migraine via meta-analysis. METHODS: Suitable randomized controlled trials (RCTs) were searched in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) to compare the efficacy of oral CGRP antagonists with that of a placebo and triptans against acute migraine. Review Manager 5.4 was used for data analysis. RESULTS: A total of 17 trials met the eligibility criteria and were studied in detail. The CGRP antagonists were significantly more effective than the placebo with respect to outcomes such as pain freedom at 2 h post-dose (odds ratio = 2.11; 95% confidence intervals [CIs] = 1.90-2.35) and pain relief at 2 h post-dose (odds ratio = 1.94; 95% CIs = 1.70-2.21). Similar results were found in the subgroup analysis conducted to compare the clinical efficacy of the FDA-approved oral CGRP antagonists (ubrogepant and rimegepant) and placebo. However, the CGRP antagonists were less effective than the triptans with respect to outcomes such as pain freedom at 2 h post-dose (odds ratio = 0.66; 95% CIs = 0.55-0.78) and pain relief at 2 h post-dose (odds ratio = 0.78; 95% CIs = 0.66-0.93). CONCLUSION:CGRP antagonists are more effective than placebo against acute migraine; however, further studies are required to consider CGRP antagonists as standard first-line treatment for acute migraine instead of triptans, especially in patients with co-existing cardiovascular diseases.
Authors: Nazir Noor; Alexis Angelette; Abby Lawson; Anjana Patel; Ivan Urits; Omar Viswanath; Cyrus Yazdi; Alan D Kaye Journal: Health Psychol Res Date: 2022-06-28
Authors: Jennifer L Nguyen; Kiraat Munshi; Samuel K Peasah; Elizabeth C S Swart; Monal Kohli; Rochelle Henderson; Chester B Good Journal: J Headache Pain Date: 2022-08-28 Impact factor: 8.588