EFFICACY OF ANTI-CGRP MONOCLONAL ANTIBODIES IN CHRONIC MIGRAINE

Abstract

Chronic migraine (CM) poses significant challenges in management, particularly among patients unresponsive to conventional preventive therapies. This randomized, double-blind, placebo-controlled trial evaluated the efficacy of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) in adults with treatment-resistant CM. A total of 200 participants were included in this study to receive monthly subcutaneous injections of either anti-CGRP mAbs (erenumab, galcanezumab, or fremanezumab) or placebo over a 12-month period. The primary endpoint was the change in monthly migraine days (MMDs) from baseline to month 12. Secondary outcomes included ≥50% reduction in MMDs, changes in Migraine Disability Assessment (MIDAS) scores, and acute medication usage. The anti-CGRP mAb group demonstrated a significant reduction in MMDs (mean decrease: 11.9 days) compared to placebo (mean decrease: 7.6 days), with a mean difference of 4.3 days (95% CI: 2.1–6.5; p<0.001). Additionally, 65% of patients in the treatment group achieved a ≥50% reduction in MMDs versus 35% in the placebo group (p<0.001). MIDAS scores improved significantly in the treatment group, indicating reduced migraine-related disability. No severe adverse events were reported. These findings underscore the superior efficacy of anti-CGRP mAbs in reducing migraine frequency and disability among patients with refractory CM, highlighting their potential as a transformative therapeutic option in this population.