To assess the efficacy of CGRP inhibitors in migraine prevention by conducting a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Calcitonin Gene-Related Peptide (CGRP) inhibitors have emerged as a promising approach in migraine prevention, reducing the frequency of migraine attacks while avoiding the typical side effects associated with other medications. Nevertheless, a comprehensive review of the efficacy of CGRP inhibitors as preventive pharmacotherapy is still warranted.

A systematic search was conducted in the PubMed/Medline, EMBASE, clinicaltrials.gov, and Cochrane databases to identify relevant RCTs involving CGRP inhibitors in migraine prevention. A pairwise meta-analysis and network meta-analysis (NMA) were conducted using the frequentist approach, to obtain both direct and indirect comparisons of each measure, as risk ratios (RR) and mean differences (MD)

A total of four RCTs, with a pooled population of 1690 migraine patients were included for analysis. Among these trials, two had participants with Episodic Migraine, one with Chronic Migraine, and one included both the populations. Atogepant (RR, 2.06; 95% CI, 1.55 to 2.72) and Rimegepant (RR, 1.18; 95% CI, 0.77 to 1.83) were more effective than placebo in 50% reduction of pain, with Atogepant being more effective than Rimegepant, as shown by the network estimate (RR, 1.74; 95% CI, 1.04 to 2.91). The mean difference from placebo in the change from baseline in monthly migraine days (MMD) were -1.96 days with Atogepant (95% CI, -2.90 to -1.01) and -0.80 days with Rimegepant (95% CI, -2.27 to 0.67) with network estimate showing Atogepant (MD, -1.16; 95% CI, -2.91 to 0.59) as more effective in reducing the number of monthly migraine days than Rimegepant, but was not statistically significant. The ranking probabilities ranked Atogepant as a superior option, followed by Rimegepant

Atogepant and Rimegepant both exhibit prophylactic efficacy in achieving significant reduction in migraine-related pain, with Atogepant showing superior efficacy.