OBJECTIVES:

This review asked: What is the safety and efficacy of CGRP inhibitors for migraine prophylaxis compared to (1) each other, (2) the standard of care (e.g. other migraine preventive medications) and (3) placebo in adults with episodic or chronic migraine?

The establishment of an ICER for patients with chronic migraine, comparing CGRP inhibitors to the standard of care in migraineurs, should be developed and proposed to better inform healthcare decision-makers.

METHODS:

MEDLINE (via PubMed), Embase, and ClinicalTrials.gov were searched through April 25, 2019 using medical subject headings and key terms for migraine headache, general drug classes, specific drug agents used for migraine prophylaxis, and study design terms to identify randomized controlled trials (RCTs). Phase 2, 3, or 4 RCTs; systematic reviews; and meta-analyses published in peer-reviewed journals were included. Study quality was analyzed using Cochrane Risk of Bias tool, resulting in ratings of high, low, or unclear risk of bias.

A cost-effectiveness analysis (CEA) proposal comparing CGRP inhibitors to beta blockers was developed using a Markov Model to establish the added benefit of utilizing CGRP inhibitors as the standard of care in adults with chronic migraine.

RESULTS:

The search identified 596 articles, with 77 duplicates removed. 16 RCTs were included in this review (all low risk of bias). Mean change in migraine days per month from baseline ranged from -2.5 to -1.7 (episodic) and -2.81 to -0.9 (chronic). With the exception of eptinezumab, all studies reporting on impact of quality of life reported statistically significant larger improvements from active treatment compared with placebo. All studies reported at least 1 adverse event, ranging from 46% to 72% (active) to 51% to 67% (control).

CONCLUSIONS:

This review aims to synthesize the evidence for safety and efficacy of CGRP inhibitors for migraine prophylaxis. More research is needed to conduct the CEA proposed.