Galcanezumab 240 mg, Fremanezumab monthly, and Eptinezumab 300 mg seem to be the three most effective CGRP monoclonal antibodies for treating migraine patients who have experienced prior therapy failures.

The objective of a network meta-analysis was to compare the efficacy of various calcitonin gene-related peptide (CGRP)-binding monoclonal antibodies (mAbs) for migraine sufferers.

A number of internet databases including ClinicalTrials.gov, Cochrane Library, Ovid EMBASE, and Ovid MEDLINE were thoroughly searched. Randomized clinical trials that evaluated any CGRP mAb  in adult migraine patients with previously failed therapy were considered. The major safety endpoint was treatment-emergent adverse events (TEAEs), and change in monthly migraine days (MMDs) was the primary effectiveness outcome.

Overall, 3052 volunteers from 7 trials were incorporated. According to a three-node analysis, CGRP mAbs were more effective than CGRP receptor mAbs at lowering MMDs (Mean difference [MD]: -1.55) and boosting response rates by at least 50% (Risk Ratio [RR]: 1.52). Notably, 240 mg Galcanezumab was the most effective treatment in terms of lowering MMDs (MD -4.40) and raising 50% response rates (RR: 4.18).

Additionally, a treatment regimen containing 300 mg of Fremanezumab or Eptinezumab offered a considerable benefit over 140 mg of Erenumab in terms of an increased response rate of a minimum of 50%. In none of the comparisons did the study reveal a difference in TEAEs and serious adverse events occurrences.

The best choice to treat migraine with prior treatment failures seems to be 300 mg Eptinezumab, monthly Fremanezumab, and 240 mg Galcanezumab.