Efficacy and Safety of CGRP Monoclonal Antibodies for Migraine Prevention in Episodic Migraine; a Network Meta-analysis

Background and Purpose: Episodic migraine is a neurological disorder characterized by recurrent, unilateral headaches that significantly impair quality of life. CGRP monoclonal antibodies, targeting calcitonin gene-related peptide (CGRP), have shown efficacy in preventing and treating episodic migraine. Methods: A systematic search of PubMed, Cochrane, and Embase databases was conducted in September 2024 to identify randomized controlled trials (RCTs) on CGRP monoclonal antibodies for episodic migraine. A network meta-analysis was performed to assess efficacy (change in monthly migraine days) and safety (incidence of adverse events). Odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) were calculated. Results: 16 studies with 9,123 participants were included. Galcanezumab (240 mg) showed the highest efficacy (SMD = 0.5012, p < 0.0001). Fremanezumab (225 mg) had the highest odds of ≥50% reduction in migraine days (OR = 3.1684, p < 0.0001). Erenumab (28 mg) showed the best safety profile (OR = 0.6815, p = 0.2220). Fremanezumab ranked highest in both efficacy (SUCRA = 84.6%) and safety (SUCRA = 61.8%). Conclusion: Fremanezumab offers the best balance of efficacy and safety. Further long-term studies are needed.