Real-world comparison of treatments with antibodies targeting the CGRP pathway or botulinum toxin type A for resistant migraine
Abstract
BACKGROUND: Migraine, particularly in its chronic and treatment-resistant forms, imposes a significant burden on patients. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway (anti-CGRP mAbs) and onabotulinum toxin type A (BTX-A) have emerged as key preventive treatments for resistant migraine. However, direct comparisons between these therapies remain limited. OBJECTIVES: This study aimed to compare the effectiveness of anti-CGRP mAbs and BTX-A in patients with resistant migraine in a real-world setting at a single tertiary care center in France. METHODS: A retrospective cohort study was conducted, including 93 patients treated with either anti-CGRP mAbs (n=50) or BTX-A (n=43) for six months. Propensity score matching and inverse probability of treatment weighting (IPTW) were applied to balance baseline differences between groups. The primary outcome was the proportion of patients achieving a ≥50% reduction in monthly headache days. RESULTS: After six months, 43% of patients in the anti-CGRP mAbs group and 18% in the BTX-A group achieved a ≥50% reduction in monthly headache days (P=0.003). Using a less stringent 30% threshold, response rates were 54% for anti-CGRP mAbs and 36% for BTX-A (P=0.06). Similar results were observed when the analysis was restricted to chronic migraine patients (n=79). The reduction in monthly headache days was significantly greater in the anti-CGRP mAbs group at both three months (P=0.015) and six months (P=0.022). CONCLUSION: Anti-CGRP mAbs demonstrated superior efficacy compared to BTX-A in resistant migraine patients.
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BibTeX
@article{gardon2026realworld,
title = {{Real-world comparison of treatments with antibodies targeting the CGRP pathway or botulinum toxin type A for resistant migraine}},
author = {L. Gardon and D. Guy and B. Pereira and S. Sickout-Arondo and C. Mongaret and N. Delage and P. Picard and S. Condé and Xavier Moisset},
journal = {Revue Neurologique},
year = {2026},
month = oct,
doi = {10.1016/j.neurol.2025.10.006},
url = {https://hal.science/hal-05794378v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Real-world comparison of treatments with antibodies targeting the CGRP pathway or botulinum toxin type A for resistant migraine
AU - L. Gardon
AU - D. Guy
AU - B. Pereira
AU - S. Sickout-Arondo
AU - C. Mongaret
AU - N. Delage
AU - P. Picard
AU - S. Condé
AU - Xavier Moisset
PY - 2026
DA - 2026/10/12
JO - Revue Neurologique
DO - 10.1016/j.neurol.2025.10.006
UR - https://hal.science/hal-05794378v1
AB - BACKGROUND: Migraine, particularly in its chronic and treatment-resistant forms, imposes a significant burden on patients. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway (anti-CGRP mAbs) and onabotulinum toxin type A (BTX-A) have emerged as key preventive treatments for resistant migraine. However, direct comparisons between these therapies remain limited. OBJECTIVES: This study aimed to compare the effectiveness of anti-CGRP mAbs and BTX-A in patients with resistant migraine in a real-world setting at a single tertiary care center in France. METHODS: A retrospective cohort study was conducted, including 93 patients treated with either anti-CGRP mAbs (n=50) or BTX-A (n=43) for six months. Propensity score matching and inverse probability of treatment weighting (IPTW) were applied to balance baseline differences between groups. The primary outcome was the proportion of patients achieving a ≥50% reduction in monthly headache days. RESULTS: After six months, 43% of patients in the anti-CGRP mAbs group and 18% in the BTX-A group achieved a ≥50% reduction in monthly headache days (P=0.003). Using a less stringent 30% threshold, response rates were 54% for anti-CGRP mAbs and 36% for BTX-A (P=0.06). Similar results were observed when the analysis was restricted to chronic migraine patients (n=79). The reduction in monthly headache days was significantly greater in the anti-CGRP mAbs group at both three months (P=0.015) and six months (P=0.022). CONCLUSION: Anti-CGRP mAbs demonstrated superior efficacy compared to BTX-A in resistant migraine patients.
SN - 0035-3787
ER -