Longitudinal effects of CGRP-targeting migraine therapies on blood pressure and body mass index: A 12-month retrospective analysis.
Publication/Presentation Date
10-25-2026
Abstract
OBJECTIVE: To compare blood pressure (BP) and body mass index (BMI) trajectories associated with individual calcitonin gene-related peptide (CGRP)-targeting migraine therapies versus matched CGRP-unexposed controls.
BACKGROUND: CGRP is a potent vasodilator with established roles in vascular homeostasis and metabolic regulation. Postmarketing surveillance identified BP elevations in erenumab-treated patients, prompting a U.S. Food and Drug Administration label update; however, comparative longitudinal data across CGRP monoclonal antibodies and gepants remain limited. Real-world evidence is needed to characterize medication-specific cardiovascular and metabolic effects in clinical practice.
METHODS: We conducted a retrospective cohort study using structured electronic health record data from the Jefferson Headache Center in Philadelphia, PA, USA (2018 to 2025). Adults initiating erenumab, fremanezumab, galcanezumab, atogepant, or preventive rimegepant were compared with propensity score-matched patients receiving migraine care without CGRP-targeting therapy. Twelve-month systolic BP (SBP), diastolic BP (DBP), and BMI trajectories were evaluated.
RESULTS: A total of 6361 patients were included (1892 controls; 4469 CGRP-treated; 80.4% female; mean age 45.6 ± 15.3 years). Controls demonstrated a positive within-group SBP trajectory (0.16 mmHg/month; 95% confidence interval [CI] 0.06 to 0.27) and BMI trajectory (0.022 kg/m
CONCLUSION: In this single-center study, CGRP-targeting therapies were not associated with greater BP increases than matched controls. Cardiometabolic trajectories varied by medication, with generally small BP differences and a robust BMI reduction with atogepant. These findings do not support a uniform adverse cardiometabolic class effect, though prospective studies with systematic monitoring are needed to confirm long-term clinical significance.
ISSN
1526-4610
Published In/Presented At
Phan, P., Keith, S., Li, M., Hass, R., Hsieh, W. J., Marmura, M., & Yuan, H. (2026). Longitudinal effects of CGRP-targeting migraine therapies on blood pressure and body mass index: A 12-month retrospective analysis. Headache, 10.1111/head.70248. Advance online publication. https://doi.org/10.1111/head.70248
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42928575
Department(s)
Administration and Leadership
Document Type
Article