Associations between oral migraine preventive regimens and CGRP monoclonal antibody initiation: real-world evidence from a resource-limited setting
Abstract
Background: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective migraine-specific preventive therapies; however, access remains limited in many low- and middle-income countries (LMICs). In such settings, oral migraine preventive medications (OMPMs) continue to serve as the foundation of preventive care. The association between baseline preventive regimens and real-world escalation to CGRP mAbs has not been well characterized.
Methods: We conducted a single-center retrospective cohort study of adults with migraine attending a university-based headache clinic in Thailand between January 2021 and December 2023. Participants with at least one baseline OMPM, no prior CGRP mAb exposure, and at least 6 months of follow-up were included. Multivariable Cox proportional hazards models, adjusted for age, sex, and migraine subtype, were used to examine associations between baseline OMPM classes and CGRP mAb initiation. A secondary analysis evaluated factors associated with discontinuation of baseline OMPMs.
Results: Among 80 participants, 16 (20.0%) initiated CGRP mAbs over 11,554 person-days of follow-up, with a median time to initiation of 44.5 days. Baseline use of beta-blockers (BBs) or tricyclic antidepressants (TCAs) was independently associated with a lower likelihood of CGRP mAb initiation (BB: adjusted hazard ratio [aHR] 0.17, 95% CI 0.04-0.66; TCA: aHR 0.12, 95% CI 0.02-0.57). In secondary analyses, baseline BB use was also associated with greater…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 80 participants or records.
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