Cerebrovascular risk with calcitonin gene-related peptide monoclonal antibodies versus onabotulinumtoxinA in patients with migraine: A real-world pharmacoepidemiologic study in the National Institutes of Health All of Us Research Program.

In a study comparing treatments for migraine, researchers evaluated calcitonin gene-related peptide monoclonal antibodies, or CGRP mAbs, and onabotulinumtoxinA. They aimed to determine if CGRP mAbs were non-inferior regarding the risk of ischemic stroke or transient ischemic attack. The study involved 16,147 patients, focusing on 1,581 CGRP mAb initiators and 947 onabotulinumtoxinA initiators. The main outcome, IS + TIA events, occurred in 14 patients using CGRP mAbs and 22 patients using onabotulinumtoxinA. The hazard ratio for IS + TIA was 0.524, indicating non-inferiority since the upper confidence bound was below 1.5. The migraine with aura subgroup also met the non-inferiority criterion. However, findings were based on few events, so caution is necessary. The study suggests that larger studies are needed to confirm safety and efficacy. Further research could shed light on these findings in diverse populations. Clinical relevance: This study indicates CGRP mAbs may be as safe as onabotulinumtoxinA for treating migraine, but more research is essential to confirm these findings.