No cardiovascular signal with anti-CGRP mAbs for migraine

Migraine treatment with monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) or its receptor does not appear to contribute to increased risk of cardiovascular disease (CVD) compared with onabotulinumtoxinA in adults, including those who are older and with disability, according to a retrospective cohort study.

Researchers used Medicare claims data from adults with migraine to compare the incidence of CVD between those who initiated anti-CGRP mAbs and those who initiated onabotulinumtoxinA. Five patient cohorts were established to minimize channelling bias from new drug introductions and time-related bias due to the COVID-19 pandemic. These cohorts represented sequential 6-month calendar intervals based on the initial prescription or date of index anti-CGRP mAbs or onabotulinumtoxinA use.

Time to first MI or stroke was the primary outcome. Secondary outcomes were hypertensive crisis, peripheral revascularization, and Raynaud phenomenon. These outcomes were assessed and compared between the treatment groups using inverse probability of treatment-weighted Cox proportional hazards models.

The analysis included 5,153 patients who initiated anti-CGRP mAbs (mean age 57.8 years, 83.6 percent female) and 4,000 patients who initiated onabotulinumtoxinA (mean age 61.9 years, 83.8 percent female).

Compared with onabotulinumtoxinA users, anti-CGRP mAb users were not at increased 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).

Similar results were obtained from subgroup analyses defined by age group and presence of established non-MI or stroke CVD.