table2_Efficacy and Safety of Monoclonal Antibody Against Calcitonin Gene-Related Peptide or Its Receptor for Migraine: A Systematic Review and Network Meta-analysis.docx

Background: The optimal monoclonal antibody against calcitonin gene-related peptide (CGRP) for adult patients with migraine has yet to be determined. Therefore, we aimed to compare the effectiveness of different monoclonal antibodies against CGRP or its receptor for adult patients with migraine through a network meta-analysis of randomized controlled trials.
Methods: We systematically searched the MEDILNE, Embase, ClinicalTrials.gov, and Cochrane Library databases for relevant publications from inception until October 30, 2020. Only randomized clinical trials of adults with migraine that assessed any calcitonin gene-related peptide monoclonal antibody and reported clinical outcomes were included. The primary outcomes were changes in monthly migraine days and treatment-emergent adverse events
Results: We initially retrieved 2,070 publications, and ultimately, 18 randomized clinical trials totaling 8,926 patients were included. In terms of efficacy, eptinezumab (MD −1.43, 95% CrI −2.59 to −0.36), erenumab (MD −1.61, 95% CrI −2.40 to −0.84), fremanezumab (MD −2.19, 95% CrI −3.15 to −1.25), and galcanezumab (MD −2.10, 95% CrI −2.76 to −1.45) significantly reduced MMDs compared with placebo. In terms of safety, only galcanezumab increased the incidences of TEAEs (RR 1.11, 95% CrI 1.01–1.22) and serious adverse events (RR 2.95, 95% CrI 1.41–6.87) compared with placebo.
Conclusion: Most drugs performed similarly and were superior to placebo in most of our analyses. Further head-to-head research on different types of CGRP monoclonal antibodies is necessary to validate the present findings.

背景：针对偏头痛成年患者的最优降钙素基因相关肽（calcitonin gene-related peptide, CGRP）单克隆抗体尚未明确。因此，本研究旨在通过随机对照试验的网络meta分析，对比不同靶向CGRP或其受体的单克隆抗体用于偏头痛成年患者的临床疗效。
方法：本研究系统检索了MEDLINE、Embase、ClinicalTrials.gov以及考克兰图书馆（Cochrane Library）数据库，检索时限为建库至2020年10月30日。纳入标准为：针对偏头痛成年患者的随机临床试验，需评估任意一种抗CGRP单克隆抗体并报告临床结局指标。本研究的主要结局指标为每月偏头痛天数（monthly migraine days, MMDs）变化与治疗突发不良事件（treatment-emergent adverse events, TEAEs）。
结果：本研究初始检索到2070篇文献，最终纳入18项随机临床试验，共计8926例患者。疗效方面，与安慰剂相比，依普奈单抗（eptinezumab，均数差MD=-1.43，95%可信区间CrI：-2.59~-0.36）、依瑞奈尤单抗（erenumab，MD=-1.61，95%CrI：-2.40~-0.84）、夫瑞奈单抗（fremanezumab，MD=-2.19，95%CrI：-3.15~-1.25）以及加卡奈单抗（galcanezumab，MD=-2.10，95%CrI：-2.76~-1.45）均可显著减少每月偏头痛天数。安全性方面，与安慰剂相比，仅加卡奈单抗可升高TEAEs发生率（相对危险度RR=1.11，95%CrI：1.01~1.22）与严重不良事件发生率（RR=2.95，95%CrI：1.41~6.87）。
结论：在本研究的多数分析中，多数受试药物疗效相近，且均优于安慰剂。未来仍需开展不同类型抗CGRP单克隆抗体的头对头研究，以验证本研究结果。