Prevention of chronic and episodic migraine with CGRP antagonists

Various treatment options are available for prevention of chronic and episodic migraine. In addition to beta blockers, calcium antagonists and antidepressants, these include monoclonal antibodies known as CGRPs. Health insurers only reimburse CGRP antagonists when at least two other preventive treatments have proven ineffective. This report investigates the efficacy and safety of CGRP antagonists, the cost-benefit ratio and the impact on the cost budget.

The literature search identified 27 clinical studies. The data show that people treated with CGRP antagonists had fewer migraine days compared with the control groups. In addition, the number of participants whose migraine days decreased by more than half and who stated that their quality of life had improved was higher in the treatment groups. Those treated with CGRP antagonists reported no particular side effects. CGRP antagonists demonstrated a better cost-benefit ratio for chronic migraine than for episodic migraine. According to the model, the costs of CGRP antagonists will rise to CHF 400 million in 2026.

The report concludes that the use of CGRP antagonists reduced the number of migraine days overall, and more than halved the number of migraine days and improved the quality of life of more people versus placebo and supportive measures in the control group. The cost-benefit ratio appears to be best for chronic migraine. A reduction in the price of CGRP antagonists would significantly improve the cost-benefit ratio and thus reduce the impact on the cost budget.