In chronic migraine people, although all the doses of anti-calcitonin gene related peptide monoclonal antibodies (anti-CGRP mAbs) were found to have similar tolerability, efficacy, and safety on the basis of uncertainties in indirect comparisons for all the outcomes, the calculated effect estimates numerically favoured elevated doses of intravenous (IV) eptinebzumab and subcutaneous (SC) fremanezumab as an efficacious treatment with acceptable tolerability and safety.

Investigators performed this systematic review and network meta-analysis to examine the effects of anti-CGRP mAbs on chronic migraine. MEDLINE, Clinical trial registries, Cochrane Central Register of Controlled Trials, and Embase were extensively explored. A network meta-analysis was performed in the Bayesian framework. In total, 38 studies (5,164 chronic migraineurs in 7 randomized trials) were incorporated with at least 12 weeks of therapy course.

In adult patients suffering from chronic migraine, SC injection of fremanezumab 675+225+225 mg once a month [QM] was found to be numerically more efficacious in decreasing migraine days (MDs) in comparison with eptinezumab 10 mg (IV) (MD: -1.52), eptinezumab 30 mg (IV) (MD: -0.33), eptinezumab 100 mg (IV) (MD: -0.59), eptinezumab 300 mg (IV) (MD: -0.02), erenumab 70 mg QM (SC) (MD: -0.17), erenumab 140 mg QM (SC) (MD: -0.18), fremanezumab 675 mg (SC) (MD: -0.30), galcanezumab 120 mg QM (SC) (MD: -0.71) and galcanezumab 240 mg QM (SC) (MD: -0.58).

But, the findings were non-significant. The study authors did not detect considerable differences for head to head comparisons of mAbs for the outcomes estimated until 12 weeks. The mAbs were found to have similar safety, efficacy and immunogenicity with no vital differences.