Study finds CGRP inhibitors not tied to glaucoma

Healio reported on May 14 that a large cohort study published in *Neurology* found no sign that CGRP inhibitors used to prevent migraine increased glaucoma risk. The analysis followed adults with migraine who started preventive treatment between 2018 and 2024 and compared patients who received CGRP inhibitors with matched patients who received other preventive drugs. Researchers tracked incident glaucoma for as long as three years after the first prescription. (healio.com) The paper was published online May 6 in the American Academy of Neurology’s journal *Neurology*. (aan.com) ### Which drugs were studied, and who was compared? The study included 73,644 people after 1:1 propensity-score matching, with 36,822 in the CGRP inhibitor group and 36,822 in the comparison group. The CGRP inhibitor arm included erenumab, fremanezumab, galcanezumab, eptinezumab, atogepant and rimegepant. The non-CGRP arm included valproate, topiramate, flunarizine, candesartan, lisinopril, metoprolol, propranolol, nadolol, amitriptyline and venlafaxine. Brown University’s Chien-Hsiang Weng said migraine and glaucoma have been linked through shared neurovascular mechanisms, while CGRP is involved in migraine biology and is also present in ocular tissues. (healio.com) Weng told Healio the researchers wanted to test whether expanding use of CGRP inhibitors in practice might have downstream effects on glaucoma risk. ### What did the researchers actually find? During follow-up, 153 people in the CGRP inhibitor group developed glaucoma, compared with 223 people in the non-CGRP group. (healio.com) That translated to 0.42% of patients in the CGRP inhibitor arm and 0.61% in the comparison arm, according to the American Academy of Neurology press release on the paper. After adjustment for factors including age, migraine frequency and hypertension history, the researchers reported a hazard ratio of 0.75 with a 95% confidence interval of 0.61 to 0.92. Healio framed the finding as showing the drugs did not appear to increase glaucoma risk, while the paper and academy release described the association as a lower risk relative to other preventive treatments. (healio.com) ### Did the signal hold across all CGRP drugs? Further analysis found the lower glaucoma risk was seen only with monoclonal antibody CGRP inhibitors, not with gepants. (aan.com) The monoclonal antibodies named in the study were erenumab, fremanezumab, galcanezumab and eptinezumab. The academy release said the reduced risk was not found with CGRP receptor antagonists, or gepants. The paper reported a hazard ratio of 0.77 with a 95% confidence interval of 0.61 to 0.98 for monoclonal antibody CGRP inhibitors versus non-CGRP users. (healio.com) It also reported lower risk estimates versus several individual comparator drugs, including topiramate, valproate, propranolol, metoprolol, lisinopril, amitriptyline and venlafaxine. ### Does this prove the drugs protect against glaucoma? The American Academy of Neurology said the study does not prove CGRP inhibitors caused the lower glaucoma risk and shows only an association. (healio.com) The design was a multinational retrospective cohort study based on health-care data, with patients followed after new prescriptions and at least one refill. Neurology classified the work as Class II evidence that CGRP inhibitor users with migraine had a lower risk of incident glaucoma than users of non-CGRP preventive drugs. That classification describes the strength of evidence in the journal’s framework, not proof of causation. (healio.com) ### What comes next for readers tracking this research? The paper is listed as *Neurology* volume 106, issue 11, with a June 9, 2026 issue date and an online publication date of May 6, 2026. (aan.com) The named authors include Chien-Chih Chou, Jr-Wei Wu, Hui-Ju Lin, I-Jong Wang, Ssu-Yu Pan and Chien-Hsiang Weng, providing the next reference point for readers who want the full cohort methods and subgroup analyses. (painresearchforum.org)