Retrospective Review of Dual CGRP-Targeted Regimens for Acute and Preventive Treatment of Migraines in a Veteran Population
Abstract
Background: Medications targeting calcitonin gene-related peptide (CGRP) have been approved for both acute treatment and prevention of migraines. Controversy surrounds the concomitant use of these agents for these 2 purposes, given their similar mechanisms of action and the limited data available to support concurrent use.
Methods: A medication use evaluation was performed using electronic health record prescription records. The primary objective was to assess the safety of dual CGRP-targeting therapies when used for both the prevention and acute treatment of migraines. A secondary exploratory objective was to assess the efficacy of combination treatment regimens. Patients were included if they had a documented diagnosis of migraine and were concomitantly using a preventive CGRP-targeting regimen and a gepant for acute migraine treatment between April 1, 2023, and January 31, 2025.
Results: The analysis included 89 patients. Most were female (60.7%), with a mean age of 46.8 years and a diagnosis of chronic migraines (76.4%). There were 149 unique dual CGRP-targeting regimens identified and included in the safety analysis, 59 of which were eligible for the exploratory efficacy analysis. No new or concerning adverse effects were identified. Only 7 adverse drug reactions were reported by patients and documented. The efficacy analysis revealed no median change in migraine intensity (0.0, P = .18) or duration (0.0, P = .92). Ten patients receiving dual CGRP therapy reported that…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 89 participants or records.
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