Summary

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• This summary is based on the review of 35 systematic review(s)/meta-analysis(es). ^[1-35]
• Reduction in Monthly Migraine Days (MMDs): Galcanezumab reduced MMDs by -2.02 days compared to placebo (MD -2.02, 95% CrI -2.62 to -1.42), while fremanezumab showed a higher reduction with -2.77 days (95% CrI -3.36 to -2.17). Eptinezumab reduced monthly headache days by -2.46 days (95% CrI: -3.23 to -1.69).
• Responder Rates: Fremanezumab demonstrated the highest 50% response rate in reducing MMDs, with a risk ratio of 2.98 (95% CI: 2.16, 4.10), while galcanezumab also showed a significant response in achieving ≥50% reduction in MMDs across various doses.
• Quality of Life Improvements: Galcanezumab significantly improved patient-reported outcomes, including the migraine-specific quality of life role function-restrictive domain (MSQ RF-R) and migraine disability assessment (MIDAS) scores.
• Comparative Effectiveness: Fremanezumab and eptinezumab often outperformed galcanezumab in specific outcomes. Galcanezumab was more effective than triptans like sumatriptan in reducing headache days but was surpassed by fremanezumab in some studies.
• General Safety: Galcanezumab demonstrated a generally favorable safety profile, with common adverse events (AEs) including injection-site pain, nasopharyngitis, and upper respiratory tract infections. Fremanezumab had higher rates of injection-site reactions but was still considered safe overall.
• Comparison to Placebo: Galcanezumab showed a slight increase in treatment-emergent adverse events (TEAEs) compared to placebo (RR 1.11, 95% CrI 1.01-1.22), but no significant differences in serious adverse events were observed between galcanezumab and placebo.
• Comparative Safety: Galcanezumab and fremanezumab had similar safety profiles, though fremanezumab had more frequent injection-site reactions. Galcanezumab had a slightly higher incidence of AEs compared to erenumab.
• Galcanezumab was particularly effective in chronic migraine patients, showing significant reductions in monthly migraine days (MMDs) and headache days. Although 85.1% of study participants were women, no conclusive gender-specific effectiveness data were reported. Additionally, galcanezumab demonstrated effectiveness in treatment-resistant chronic migraine patients, though some experienced a wearing-off effect over time.