Efficacy And Safety Of CGRP Receptor Antagonist For The Acute Treatment Of Migraine: A Meta Analysis

Objective:Among various theories of migraine pathogenesis,trigeminal neurovascular theory has received extensive attention in recent years,and based on the important role of calcitonin gene-related peptide(CGRP)in trigeminal neurovascular theory,the study of its receptor antagonist on preventing migraine acute attack has become a hot spot in the development of new drugs for migraine treatment.The first generation of CGRP receptor antagonists have not been further applied in clinical practice due to their low bioavailability and liver toxicity.The efficacy,safety and tolerance of second-generation CGRP receptor antagonists have improved.Rimegepant and Ubrogepant have been approved by THE US Food and Drug Administration(FDA)for the treatment of acute migraine attacks,but their safety remains controversial.This study aims to systematically evaluate the efficacy and safety of two CGRP receptor antagonists Rimegepant and Ubrogepant in the treatment of migraine during acute attack stage by means of meta-analysis,in order to provide evidence-based reference for clinical use.Methods:We search randomized clinical trials(RCTs)of CGRP receptor antagonists in the treatment of acute migraines on Pub Med,Embase,The Cochrane Library database and Clinical Trials.gov,from the database up to November 1,2021.Literature selection,data extraction and quality evaluation were independently conducted by two professional researchers according to inclusion and exclusion criteria.Finally,we use Rev Man5.4software to conducte meta-analysis.Results:A computer search of the database yielded 265 articles,including two CGRP receptor antagonists,Ubrogepant,Rimegepant and placebo,and seven articles were included for meta-analysis,involving 7842 subjects,including 1012 males and 6812 females.In terms of efficacy,Ubrogepant and Rimegepant showed significant differences in primary and secondary outcomes compared with placebo.There were no significant differences in safety and tolerability compared with placebo.Conclusion:Rimegepant and Ubrogepant have shown good efficacy and tolerability when used for the acute phase of migraine and can be recommended as such,especially for patients who have migraine combined with cardiovascular and especially abstain from triptans.