Abstract Details

Title CGRP Monoclonal Antibodies vs Gepants: Risk of Vascular Outcomes: A TriNetX Multicenter Electronic Medical Record Analysis

Topic Headache

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-012

Objective To characterize patient demographics and vascular risk in individuals with migraine prescribed calcitonin gene-related peptide (CGRP) inhibitors, including monoclonal antibodies (mAbs) and antagonists (gepants).

Background In March 2025, FDA labeling for gepants was updated to include potential risks of hypertension (HTN) and Raynaud’s phenomenon (RP). The CGRP mAb erenumab label also warns of new-onset or worsening HTN. Real-world evidence comparing vascular risk between mAbs and gepants remains limited.

Design/Methods We conducted a cross-sectional study using the TriNetX® database to identify adults with migraine (ICD-10 G43) prescribed CGRP mAbs (erenumab, galcanezumab, fremanezumab, eptinezumab) or gepants (atogepant, rimegepant). Demographics, comorbidities, and medication profiles were balanced via 1:1 nearest-neighbor propensity score matching. Relative risk ratios (RR, 95% confidence interval) for incident HTN, RP, and stroke following the index event were calculated, excluding patients with prior vascular diagnoses.

Results Matched cohorts included 146,934 patients. Compared to gepants, mAbs were associated with a higher RR of HTN (1.43, 1.39–1.47), RP (1.47, 1.36–1.59), and stroke (1.31, 1.22–1.40). Never-CGRP users compared to mAb users had increased RR of HTN (1.80, 1.68–1.93) and stroke (1.92, 1.69–2.18), with similar RP (1.07, 0.89–1.29). Never-CGRP users compared to gepant users had a higher RR of HTN (RR 2.15, 2.04–2.27), RP (1.25, 1.08–1.44), and stroke (1.29, 1.20–1.40).

Conclusions CGRP mAbs were linked to greater vascular risk than gepants. Elevated risk among never-users may reflect underlying clinical characteristics, prescribing patterns, and possibly a protective effect of CGRP inhibitors. These findings stress the need for prospective studies to clarify causality and guide vascular safety monitoring.

Authors/Disclosures
Mateus D. Franco, MD PRESENTER	An immediate family member of Mr. Franco has received research support from Pfizer Brazil . Mr. Franco has received personal compensation in the range of $500-$4,999 for serving as a Second Lieutenant with Brazilian Army . Mr. Franco has a non-compensated relationship as a Member with Abraces - Brazilian Association for Cluster Headache and Migraine. that is relevant to AAN interests or activities.
Victor Wang, MD (Thomas Jefferson University Hospital)	Dr. Wang has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Wang has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie.
Karyn Ding, MD	Dr. Ding has nothing to disclose.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.
Vitoria Acar, MD	Dr. Acar has received research support from Pfizer Brazil. Dr. Acar has a non-compensated relationship as a Volunteer/ advocacy with ABRACES that is relevant to AAN interests or activities.

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