A study led by the Pharmacy and Neurology Services, with the collaboration of Impuls Digital, has evaluated the persistence, effectiveness, and tolerability of monoclonal antibodies targeting the calcitonin gene-related peptide (anti-CGRP) in patients with chronic migraine (CM) under real-world clinical conditions. Anti-CGRPs are drugs that work to prevent migraines, helping to reduce the pain burden on patients. The drugs studied include erenumab, fremanezumab, and galcanezumab.
If a patient is treated with one drug and does not improve, switching to another is possible, as even in a third of cases, the patient may respond to the change.
The retrospective and observational study included 281 patients treated with anti-CGRP between January 2019 and December 2022 at the Hospital de Sant Pau. Treatment persistence was measured, as well as the percentage of patients who maintained the treatment at 3, 6, and 12 months. Effectiveness was defined as a ≥50% reduction in the number of monthly migraine days (MMD), and tolerability was measured by the number and type of adverse events reported.
The results, published in the journal Headache, showed that treatment persistence at 12 months was higher with the first anti-CGRP treatment (66.7%) compared to the second (49.8%) and third (37.2%). Regarding effectiveness, a ≥50% reduction in MMD was achieved in 57.6% of patients with the first treatment at 3 months, while only 25.0% and 11.8% of patients achieved this response with the second and third treatments, respectively. In terms of tolerability, 55 adverse events were reported in 43 patients (15.3%), mostly mild, and only 14 patients (5.0%) discontinued treatment due to these effects.
The study concludes that persistence with anti-CGRP treatment is higher with the first anti-CGRP treatment and decreases with subsequent treatments, especially when the change is due to lack of effectiveness or severe adverse effects. Additionally, it confirms that the tolerability profile of anti-CGRP monoclonal antibodies is favorable, with a relatively low number of treatment discontinuations due to side effects.
The researchers emphasize the need for further studies to identify predictors of response after changes in anti-CGRP treatment in patients with chronic migraine.
De Dios A, Pagès-Puigdemont N, Ojeda S, Riera P, Pelegrín R, Morollon N, Belvís R, Real J, Masip M. Persistence, effectiveness, and tolerability of anti-calcitonin gene-related peptide monoclonal antibodies in patients with chronic migraine. Headache. 2024 Sep 13. doi: 10.1111/head.14827. Epub ahead of print. PMID: 39268992.
