4CPS-056 Efficacy of anti-calcitonin gene-related peptide therapies in chronic migraine: an indirect treatment comparison

<h3>Background and Importance</h3> Several treatments targeting the calcitonin gene-related peptide (CGRP) pathway are used for the prevention of chronic migraine (CM). There are no head-to-head comparisons of these drugs to help guide therapeutic positioning. <h3>Aim and Objectives</h3> To analyse whether fremanezumab, galcanezumab, erenumab, eptinezumab and atogepant could be considered as equivalent therapeutic alternatives (ETA) in CM using an adjusted indirect treatment comparison (ITC). <h3>Material and Methods</h3> A systematic bibliographic search of Pubmed for clinical trials (CTs) was performed. Inclusion criteria: phase II/III, randomised with similar populations, comparator, follow-up period and CM definition (15 headache days/month, of which 8 were migraine days). The comparative efficacy endpoint was a 50% reduction in migraine days/month (measured after 12 weeks of treatment). ITC was performed using the Bucher method. The delta value (∆, maximum acceptable difference used as a clinical criterion of equivalence) was calculated according to the ETA guidelines(1): half of the absolute risk reduction (ARR) obtained in the meta-analysis of RCTs used for the ITC (pooled ARR: 17%, ∆: 7.5%). <h3>Results</h3> Five randomised CTs were finally selected, one per treatment. The rest were not included in the ITC because they did not meet the inclusion criteria. The results of the ITC are shown in the table 1: <h3>Conclusion and Relevance</h3> ITC showed no statistically or clinically significant differences among fremanezumab, erenumab, eptinezumab and atogepant. Nevertheless, significant statistical and clinical differences were identified between galcanezumab and the other options. <h3>References and/or Acknowledgements</h3> Alegre-Del Rey EJ, Fénix-Caballero S, Castaño-Lara R, Sierra-García F. Assessment and positioning of drugs as equivalent therapeutic alternatives. <i>Med Clin(Barc)</i>. 2014;<b>143</b>(2):85–90. <h3>Conflict of Interest</h3> No conflict of interest