Anti-CGRP monoclonal antibodies pose no increased CVD risk

Monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) or its receptor do not appear to contribute to heightened risk of cardiovascular disease (CVD) relative to onabotulinumtoxinA in adults with migraine at high CVD risk, according to a study.

Researchers used Medicare claims data and identified adult beneficiaries with migraine who initiated either anti-CGRP mAbs or onabotulinumtoxinA. Those with a history of myocardial infarction (MI), stroke, cluster headache, malignant cancer, or hospice service within a 1-year baseline period prior to treatment initiation were excluded.

Time to first MI or stroke was the primary outcome. Hypertensive crisis, peripheral revascularization, and Raynaud phenomenon were also assessed as secondary outcomes. The inverse probability treatment-weighted Cox proportional hazards models were used in the analysis.

Of the 266,848 beneficiaries with migraine, 5,153 initiated anti-CGRP mAbs (mean age 57.8 years, 83.6 percent female) and 4,000 initiated onabotulinumtoxinA (mean age 61.9 years, 83.8 percent female).

Compared with onabotulinumtoxinA initiators, anti-CGRP mAb initiators were not at higher risk of composite CVD events (adjusted hazard ratio [aHR], 0.88, 95 percent confidence interval [CI], 0.44–1.77), hypertensive crisis (aHR, 0.46, 95 percent CI, 0.14–1.55), peripheral revascularization (aHR, 1.50, 95 percent CI, 0.48–4.73), or Raynaud phenomenon (aHR, 0.75, 95 percent CI, 0.45–1.24).

Subgroup analyses defined by age and presence of established non-MI or stroke CVD yielded similar results.