Calcitonin Gene-related Peptide-Targeting Therapies for Prevention of Migraine

Publication Date: March 11, 2024
Last Updated: April 19, 2024

Summary of Statements

  • There is solid human evidence that establishes CGRP as a fundamental mechanism of migraine and therefore establishes CGRP-targeting therapies as “migraine-specific” in contrast to all the other established therapies.
  • The cumulative evidence for the efficacy, safety, and tolerability of CGRP-targeting therapies is significantly greater than that for any established migraine preventive therapy. The remarkable tolerability of the CGRP-targeting therapies is a particularly positive feature.
  • Nearly all CGRP-targeting therapies are FDA-approved for the preventive treatment of both episodic and chronic migraine, which simplifies decision-making in patients who may spontaneously transition back and forth between episodic and chronic migraine.
  • There are multiple categories of evidence supporting the use of CGRP-targeting therapies that do not exist for other migraine preventive therapies, including: responder rates, efficacy in patients with multiple prior treatment failures, efficacy in those with acute medication overuse, and those who do and do not have aura.
  • There is one head-to-head study demonstrating the superiority of a CGRP-targeting therapy (erenumab) over an established migraine preventive therapy (topiramate). In addition, multiple studies indicating the efficacy of CGRP-targeting migraine preventive therapies in those who have previously failed multiple other established treatments provide indirect evidence of the superiority of CGRP-targeting therapies for some patients.
  • Acknowledging CGRP-targeting therapies as first-line approaches will increase the likelihood that their efficacy and safety will be more thoroughly evaluated in understudied populations, particularly youth.
  • Cost considerations regarding migraine therapies should include not only the direct cost of the treatments, but also the indirect costs of healthcare utilization and acute therapies, as well as socioeconomic costs for those who are disabled by the disease.

Overview

Title

Calcitonin Gene-related Peptide-Targeting Therapies for Prevention of Migraine

Authoring Organization

American Headache Society