Real-world comparison of treatments with antibodies targeting the CGRP pathway or botulinum toxin type A for resistant migraine
Abstract
BACKGROUND: Migraine, particularly in its chronic and treatment-resistant forms, imposes a significant burden on patients. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway (anti-CGRP mAbs) and onabotulinum toxin type A (BTX-A) have emerged as key preventive treatments for resistant migraine. However, direct comparisons between these therapies remain limited.
OBJECTIVES: This study aimed to compare the effectiveness of anti-CGRP mAbs and BTX-A in patients with resistant migraine in a real-world setting at a single tertiary care center in France.
METHODS: A retrospective cohort study was conducted, including 93 patients treated with either anti-CGRP mAbs (n=50) or BTX-A (n=43) for six months. Propensity score matching and inverse probability of treatment weighting (IPTW) were applied to balance baseline differences between groups. The primary outcome was the proportion of patients achieving a ≥50% reduction in monthly headache days.
RESULTS: After six months, 43% of patients in the anti-CGRP mAbs group and 18% in the BTX-A group achieved a ≥50% reduction in monthly headache days (P=0.003). Using a less stringent 30% threshold, response rates were 54% for anti-CGRP mAbs and 36% for BTX-A (P=0.06). Similar results were observed when the analysis was restricted to chronic migraine patients (n=79). The reduction in monthly headache days was significantly greater in the anti-CGRP mAbs group at both three months (P=0.015) and six months (P=0.022).…
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: 93 participants or records.
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