More Research Backs Migraine Meds as Heart Safe

TOPLINE:

The use of anti–calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAbs) was not linked to increased risk for a cardiovascular disease (CVD) event in a cohort study of older adults with migraine.

METHODOLOGY:

• Researchers conducted a retrospective, sequential cohort study from 2018 to 2020, analyzing data from Medicare beneficiaries aged 18 years or older with migraine.
• Beneficiaries with a history of myocardial infarction, stroke, cluster headache, cancer, or hospice service within 1 year prior to treatment initiation were excluded.
• Of the eligible patients included, 5153 initiated the use of anti-CGRP mAbs (mean age, 57.8 years; 84% women) and 4000 initiated the use of onabotulinumtoxinA (mean age, 61.9 years; 84% women).
• The primary outcome was the first occurrence of a composite CVD event of myocardial infarction or stroke.

TAKEAWAY:

• The use of anti-CGRP mAbs was not significantly associated with increased risk for a composite CVD event of myocardial infarction or stroke (adjusted hazard ratio[aHR], 0.88; 95% CI, 0.4-1.8).
• No differences in risk were identified when CVD outcomes were assessed separately.
• In addition, there were no significant differences in risk for hypertensive crisis (aHR, 0.46; 95% CI, 0.1-1.6), peripheral revascularization (aHR, 1.5; 95% CI, 0.5-4.7), or Raynaud phenomenon (aHR, 0.75; 95% CI, 0.5-1.2) between the treatment groups.
• Subgroup analyses, stratified by age and presence of established CVD, confirmed comparable risks for composite CVD events between the two groups.

IN PRACTICE:

“Given that many other migraine medications, such as triptans, have CVD contraindications and that the off-label use of oral preventive medications often results in significant adverse effects and tolerability issues, demonstrating the CVD safety of anti-CGRP mAbs, despite their theoretical risk, is crucial,” the investigators wrote. They added that additional studies with longer follow-ups and in more patient populations are needed to confirm their findings.

SOURCE:

This study was led by Wei-Hsuan Lo-Ciganic, PhD, Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh. It was published online on January 6 in JAMA Neurology.

LIMITATIONS:

The misclassification of anti-CGRP mAb exposure may have occurred due to drug access through patient assistance programs, and claims data lacked explicit prescription indications for onabotulinumtoxinA use. The absence of validation studies for exploratory outcomes in claims data also limited the ability to draw strong conclusions, unmeasured or residual confounding remained possible due to missing detailed clinical information, and the limited sample size prevented the evaluation of effects specific to individual drugs and doses. Additionally, the rarity of CVD events led to wide CIs and imprecise incidence estimates during the short follow-up period; and the findings may not be generalizable to Medicaid or commercially insured populations in the United States.

DISCLOSURES:

The investigators provided no funding information. Four did report having received grants or consulting fees from various organizations, including national institutes, pharmaceutical companies, and foundations, and disclosed having relevant affiliations. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.