Network Meta-Analysis Ranks Anti-CGRP Migraine Drugs: Fremanezumab Best at 6 Weeks, Erenumab at 12
Network meta-analysis of anti-CGRP migraine drugs found fremanezumab 900mg most effective at 6 weeks for both chronic and episodic migraine, while erenumab 140mg was most effective at 8 and 12 weeks.
Quick Facts
What This Study Found
At 6 weeks: fremanezumab 900mg most effective (SMD=-0.55). At 8 weeks: erenumab 140mg most effective (SMD=-0.51). At 12 weeks: erenumab 140mg most effective (SMD=-0.48). For chronic migraine: fremanezumab 900mg best at 6 weeks, erenumab 140mg best at 8 and 12 weeks.
Key Numbers
6wk: fremanezumab 900mg SMD -0.55; 8wk: erenumab 140mg SMD -0.51; 12wk: erenumab 140mg SMD -0.48; drugs: erenumab, eptinezumab, fremanezumab, galcanezumab
How They Did This
Systematic review and network meta-analysis. SCOPUS, PubMed, Cochrane, Embase through January 2019. RCTs of erenumab, eptinezumab, fremanezumab, galcanezumab vs placebo. Efficacy at 6, 8, and 12 weeks. Episodic and chronic migraine analyzed separately and combined.
Why This Research Matters
Choosing between four similar drugs is difficult without comparative data. This NMA provides evidence-based rankings by timepoint and migraine type, enabling more informed prescribing decisions.
The Bigger Picture
As more anti-CGRP drugs compete, comparative effectiveness research becomes essential. This NMA shows that drug ranking depends on the timeframe — suggesting that patient expectations should be set accordingly.
What This Study Doesn't Tell Us
NMA relies on indirect comparisons. Head-to-head trials between anti-CGRP drugs are limited. Effect sizes are modest. Long-term (>12 week) comparisons not assessed. Dose comparisons limited.
Questions This Raises
- ?Would fremanezumab maintain its advantage with continued quarterly dosing beyond 6 weeks?
- ?Why does the relative efficacy ranking change over time?
- ?Should drug choice be based on expected treatment duration?
Trust & Context
- Key Stat:
- Timing matters for drug choice Fremanezumab worked fastest (best at 6 weeks) but erenumab provided superior sustained effect (best at 8-12 weeks) — drug choice may depend on how quickly relief is needed
- Evidence Grade:
- Moderate-to-high evidence: network meta-analysis of randomized controlled trials, though indirect comparisons between drugs have inherent limitations.
- Study Age:
- Published 2021. Data through January 2019. Additional clinical experience has accumulated since, though relative rankings may remain similar.
- Original Title:
- Efficacy of calcitonin gene-related peptide (CGRP) receptor blockers in reducing the number of monthly migraine headache days (MHDs): A network meta-analysis of randomized controlled trials.
- Published In:
- Journal of the neurological sciences, 427, 117505 (2021)
- Authors:
- Masoud, Ahmed Taher, Hasan, Mohammed Tarek(2), Sayed, Ahmed, Edward, Harvey Nabil, Amer, Ahmed Mohamed, Naga, Abdelrahman Elshahat, Elfil, Mohamed, Alghamdi, Badrah S, Perveen, Asma, Ashraf, Ghulam Md, Bahbah, Eshak I
- Database ID:
- RPEP-05587
Evidence Hierarchy
Combines results from multiple studies to find an overall pattern.
What do these levels mean? →Frequently Asked Questions
Which anti-CGRP migraine drug is best?
It depends on timing needs. Fremanezumab (Ajovy) at 900mg quarterly worked fastest — best at 6 weeks. Erenumab (Aimovig) at 140mg monthly was best at 8-12 weeks for sustained effect. Both work for episodic and chronic migraine.
Should I switch if my anti-CGRP drug isn't working at first?
This NMA shows that some drugs work faster than others. If your drug hasn't worked by 12 weeks, switching may be warranted. But some anti-CGRP drugs that are less effective at 6 weeks become more effective by 12 weeks — patience may pay off.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-05587APA
Masoud, Ahmed Taher; Hasan, Mohammed Tarek; Sayed, Ahmed; Edward, Harvey Nabil; Amer, Ahmed Mohamed; Naga, Abdelrahman Elshahat; Elfil, Mohamed; Alghamdi, Badrah S; Perveen, Asma; Ashraf, Ghulam Md; Bahbah, Eshak I. (2021). Efficacy of calcitonin gene-related peptide (CGRP) receptor blockers in reducing the number of monthly migraine headache days (MHDs): A network meta-analysis of randomized controlled trials.. Journal of the neurological sciences, 427, 117505. https://doi.org/10.1016/j.jns.2021.117505
MLA
Masoud, Ahmed Taher, et al. "Efficacy of calcitonin gene-related peptide (CGRP) receptor blockers in reducing the number of monthly migraine headache days (MHDs): A network meta-analysis of randomized controlled trials.." Journal of the neurological sciences, 2021. https://doi.org/10.1016/j.jns.2021.117505
RethinkPeptides
RethinkPeptides Research Database. "Efficacy of calcitonin gene-related peptide (CGRP) receptor ..." RPEP-05587. Retrieved from https://rethinkpeptides.com/research/masoud-2021-efficacy-of-calcitonin-generelated
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.