Monoclonal antibody treatments for migraine are effective, well-tolerated, and expensive

Reference

Loder E, Renthal W. Calcitonin gene-related peptide monoclonal antibody treatments for migraine. JAMA Intern Med 2019;179(3):421–422.

Synopsis

These authors conducted a network meta-analysis to compare the monoclonal antibodies fremanezumab and erenumab to placebo and other available prophylactic treatments. This approach allows the researchers to compare results when head-to-head studies are not available. They identified studies using 3 databases, including the Cochrane Central Register of Controlled Trials, as well as information from manufacturers and regulatory bodies. The good news is the studies were of good quality; the bad news is there were no head-to-head trials of either new treatment against each other or any preventive treatment, and the duration of trials was short. Consequently, we have to view these findings as preliminary until better information is available. For episodic migraine, both drugs are more effective than placebo but not superior to propranolol or topiramate for reducing the number of migraine days or the proportion of people experiencing a 50% or more reduction in migraine days. For chronic migraine, treatment produced a small decrease in the number of migraine days (1.3 - 2.4 per month) as compared with placebo, but there was not enough evidence to show they are equivalent to other treatments. Treatments (both are injected) are well-tolerated. The cost works out to be $100 to $140 US for each migraine-free day for chronic pain and $150 to $160 US for each episodic migraine prevented.