Patient Sex in Prescribing CGRP Receptor Antagonists for Migraine

To the Editor In a recent JAMA Neurology Viewpoint,¹ Porreca and Dodick raised an important issue by discussing gender differences in outcomes of calcitonin gene-related peptide (CGRP) receptor antagonists in migraine treatment. Their point of view is supported by a pooled pivotal trial data analysis, which showed that there was no therapeutic gain seen in the male population for migraine short-term treatment with either ubrogepant or rimegepant. Their point of view is also supported by a body of experimental animal and human data showing that the involvement of CGRP is probably sexually dysmorphic. Such a sexual dysmorphism implies that the influence of gender should affect both gepants and monoclonal antibodies targeting CGRP (CGRP-mAbs). The discussion on CGRP-mAbs data is absent from Porreca and Dodick’s Viewpoint.¹