OBJECTIVES

Head-to-head randomized, controlled trials(RCTs) comparing efficacy of monoclonal antibodies targeting the calcitonin gene-related peptide(CGRP) pathway for preventive migraine treatment are not available. This network meta-analysis(NMA) assessed relative efficacy of fremanezumab and galcanezumab on Migraine-specific Quality of Life Questionnaire(MSQ) scores in patients with chronic or episodic migraine(CM or EM) with multiple prior treatment failures.

METHODS

The MSQ evaluates impact of migraine on 3 health-related quality-of-life domains: role-function-restrictive(RFR), role function-preventive(RFP), and emotional function(EF). A systematic literature review(SLR) was conducted to identify placebo-controlled RCT evaluating effects of fremanezumab quarterly(675mg) and monthly(225mg) or galcanezumab(120mg) on MSQ in CM or EM patients with 2-4 and ≥3 prior preventive failures. A NMA within a Bayesian framework examined change from baseline in MSQ domain scores in 2 subgroups (2-4 and ≥3 prior failures). Data presented here are for CM and EM patients combined.

RESULTS

The SLR identified 2 RCTs in CM and EM patients; the NMA evaluated changes in MSQ scores from baseline over weeks 9-12 (based on available data). Median increases in RFR scores were statistically significantly greater for fremanezumab quarterly, fremanezumab monthly, and galcanezumab, respectively, versus placebo in the 2-4 prior failures subgroup (8.7 points[95% credible interval(CrI):4.88,12.55], 10.59[6.78,14.42], and 12.52[8.72,16.27]) and ≥3 prior failures subgroup (10.74[5.19,16.37], 11.84[6.33,17.30], and 15.28[7.72,22.98]). Median increases in RFR scores were similar with no statistically significant differences for galcanezumab versus fremanezumab quarterly and monthly, respectively, in the 2-4 prior failures subgroup (3.84[95% CrI: −1.52,9.20] and 1.93[−3.47,7.22]) and ≥3 prior failures subgroup (4.53[−4.84,13.96] and 3.43[−5.78,12.78]). Similar results were shown for the RFP and EF scores in the 2-4 prior failures subgroup.

CONCLUSIONS

Both fremanezumab and galanezumab showed statistically significant and clinically meaningful increases in MSQ scores versus placebo in migraine patients with multiple prior preventive failures. Across all 3 MSQ domains, no statistically significant differences were noted between fremanezumab and galcanezumab.