Matching adjusted indirect comparison of acupuncture versus fremanezumab in the preventive treatment of episodic migraine

Abstract

Objective

Acupuncture and fremanezumab are second-line treatments for migraine prophylaxis. We aimed to compare acupuncture with fremanezumab in the preventive treatment of episodic migraine by using a matching-adjusted indirect comparison analysis (MAIC).

Methods

We acquired participant-level data from an acupuncture trial recruiting 302 participants and summary-level data from a fremanezumab trial recruiting 875 participants (290 participants received monthly fremanezumab [MF] and 291 received single-dose fremanezumab [SF]). The primary outcome was the mean reduction in monthly headache days. The secondary outcomes were the mean reduction in monthly moderate-to-severe headache days, days with acute medication, and the adverse events rate.

Results

Before matching, the acupuncture arm had significantly lower BMI, fewer headache days with at least moderate severity, and fewer days with acute medication. After matching, the baseline variables were comparable between groups. The three arms had no difference in the change of monthly migraine days (MF vs. acupuncture: mean difference 0.3, 95%CI −0.5 to 1.1, p-value = 0.473; SF vs. acupuncture: mean difference 0.5, 95%CI −0.3 to 1.3, p-value = 0.214). The results were similar in the analyses of secondary outcomes sensitivity analyses. Thirty-six (25%) participants in the acupuncture arm reported adverse events, versus 192(66%) participants in the MF arm and 193 (66%) in the SF arm.

Conclusion

The preventive treatment effect of acupuncture is equivalent to fremanezumab, and it presented with a lower adverse event rate, which indicates that acupuncture can be an alternative to fremanezumab.

Keywords:

• Acupuncture
• fremanezumab
• matching adjusted indirect comparison
• migraine prophylaxis

Transparency

Declaration of funding

Hui Zheng received a grant from the Sichuan Youth Science and Technology Innovation Research Team (no. 2021JDTD0007). The sponsors had no role in the design and conduct of the study, and they had no role in the decision process to submit the manuscript for publication.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HZ designed the study. HZ, SQF, YZS, and JTL acquired, analyzed, and interpreted the data. HZ drafted the first version of the manuscript. All authors revised the manuscript. YL supervised the study and provided technical support.

Data availability statement

All authors agree to share the study data after the publication of the article. The data will be acquired upon reasonable request.

Additional information

Funding

Hui Zheng received a grant from the Sichuan Youth Science and Technology Innovation Research Team (no. 2021JDTD0007). The sponsors had no role in the design and conduct of the study, and they had no role in the decision process to submit the manuscript for publication.