CGRP Monoclonal Antibodies Not Tied to COVID-19 Risk in Veterans With Migraine

Treatment with CGRP monoclonal antibodies was not associated with COVID-19 risk or severe clinical outcomes from COVID-19 in US veterans with migraine.

Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatment did not show any association with positive SARS-CoV-2 test results or increased risk for severe COVID-19 outcomes. This suggests that CGRP mAbs may potentially be used for migraine prevention. These are the findings of a study published in JAMA Network Open.

Researchers conducted a retrospective cohort study and reported on the correlation between CGRP mAb treatment and the risk for SARS-CoV-2 infection and specific severe outcomes: hospitalization, oxygen supplementation, mechanical ventilation, or mortality within 30 days.

Veterans from the United States aged 18 to 65 years with at least a 12-month history of migraine disorder who were at risk for COVID-19 between January 2020 to May 2022 were eligible to be included.

A total of 9992 individuals (mean age, 46.0 years; 53.9% men) initiated CGRP mAbs, while 8,168,660 individuals (mean age, 46.6 years; 65.7% men) did not initiate. Throughout a 28-month follow-up period, 1247 of the initiators (12.5%) and 780,575 of the noninitiators (9.6%) tested positive for SARS-CoV-2.

CGRP mAbs may be used for migraine prevention among patients who are at risk of or have COVID-19.

Compared with noninitiators, CGRP mAb initiators had a higher proportion of women and urban residents at baseline. Additionally, they were nonsmokers, diagnosed with chronic migraine, or were immunocompromised. Initiators were also prescribed triptans and migraine prophylaxis medications, had higher healthcare utilization, and a higher number of SARS-CoV-2 tests.

Within the 2 groups, 565 initiators (5.7%) and 771,215 noninitiators (9.4%) tested positive for SARS-CoV-2. Initiators receiving CGRP mAbs had a median duration of 5 months (IQR, 2-11 months).

The incidence of SARS-CoV-2 infection was 7.4 cases per 1000 person-months for initiators and 6.9 cases per 1000 person-months for noninitiators.

The observational analog of the intention-to-treat hazard ratio (HR) was calculated at 0.95 (95% CI, 0.89-1.01), suggesting no significant difference between initiators and noninitiators.

Initiators exhibited significantly lower levels of ferritin (median, 148.0 ng/mL [IQR, 77.0-279.0 ng/mL] vs 290.0 ng/mL [IQR, 12.0-650.5 ng/mL]; P =.05) and procalcitonin (median, 0.05 ng/mL [IQR, 0.05-0.06 ng/mL] vs 0.07 ng/mL [IQR, 0.05-0.15 ng/mL]; P =.04) compared to noninitiators.

No notable distinctions were found between initiators and noninitiators in terms of hospitalization (odds ratio [OR], 0.93; 95% CI, 0.62-1.41), requiring supplemental oxygen (OR, 0.77; 95% CI, 0.45-1.30), use of mechanical ventilation (OR, 0.85; 95% CI, 0.26-2.84), or mortality (OR, 0.67; 95% CI, 0.09-5.23).

A limitation of this study included the median 5-month duration of CGRP mAb treatment, which restricted the assessment of long-term outcomes.“[T]here was no significant difference in the incidence of COVID-19 or sequela hospitalization between CGRP mAb recipients and nonrecipients, suggesting that CGRP mAbs may be used for migraine prevention among patients who are at risk of or have COVID-19,” the researchers wrote. They concluded, “[T]here were few events of requiring supplemental oxygen, use of mechanical ventilation, and death among CGRP mAb initiators, indicating that replication analysis in a larger sample of patients later in the course of disease may be warranted.”


Wang K, Fenton BT, Deng Y, et al. Calcitonin gene–related peptide monoclonal antibodies and risk of SARS-CoV-2 infection and severe COVID-19 outcomes among veterans with migraine disorder. JAMA Netw Open. Published online July 31, 2023. doi:10.1001/jamanetworkopen.2023.26371