To evaluate the effectiveness of calcitonin gene-related peptide (CGRP) targeted therapies in reducing monthly migraine headache days specifically in patients with chronic migraine.
Key Findings:
CGRP therapies reduced monthly migraine headache days by approximately 2 days compared to placebo.
High-certainty evidence supports eptinezumab, erenumab, fremanezumab, galcanezumab, and atogepant for reducing migraine days.
Fremanezumab and erenumab showed high-certainty evidence for achieving at least a 50% reduction in migraine days.
Galcanemab likely reduced dropout rates compared to placebo, while erenumab and atogepant increased constipation and nausea risks.
Botulinum toxin may reduce migraine days but has low evidence certainty and increased discontinuation due to adverse events.
Rimegepant probably had little or no effect on monthly migraine headache days in mixed chronic and episodic populations.
Interpretation:
Most CGRP-targeted therapies are likely effective for chronic migraine prophylaxis, but further independent head-to-head trials and longer-term studies are needed to confirm long-term safety and efficacy.
Limitations:
Most trials were industry funded, raising potential bias.
Median follow-up was only 12 weeks, limiting long-term safety conclusions.
Sparse comparative data prevented planned network meta-analysis.
High risk of bias in older preventive therapies limits confidence in findings.
Conclusion:
CGRP-targeted therapies are probably effective for chronic migraine, but larger independent trials and longer-term studies are necessary.
A nationwide Korean cohort study found modestly higher Parkinson's disease incidence among patients with asthma or allergic rhinitis, with stronger associations observed among patients with greater allergic disease burden.
