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. 2023 Sep;20(5):1284-1293.
doi: 10.1007/s13311-023-01394-0. Epub 2023 Jul 10.

Long-Term Effect of Switching From an Anti-CGRP Receptor to an Anti-CGRP Ligand Antibody in Treatment-Refractory Chronic Migraine: A Prospective Real-World Analysis

Giorgio Lambru  1   2 , Valeria Caponnetto  3   4 , Bethany Hill  3 , Susanna Ratti  4 , Simona Sacco  4 , Madeleine Murphy  3 , Jessica Briscoe  3 , Anna P Andreou  3   5
Affiliations

Long-Term Effect of Switching From an Anti-CGRP Receptor to an Anti-CGRP Ligand Antibody in Treatment-Refractory Chronic Migraine: A Prospective Real-World Analysis

Giorgio Lambru et al. Neurotherapeutics. 2023 Sep.

Abstract

In migraine patients with a poor response to a calcitonin gene-related peptide monoclonal antibody against the receptor, switching to a calcitonin gene-related peptide monoclonal antibodies against the ligand may be beneficial. This was a long-term real-world prospective analysis conducted in treatment-refractory chronic migraine patients coming from two large tertiary referral headache centres, who did not achieve a meaningful response to erenumab and were switched to fremanezumab. Responders to fremanezumab were considered those who achieved at least 30% reduction in monthly migraine days by month 3, compared to the post-erenumab baseline. Secondary efficacy and disability outcomes were analysed. Thirty-nine patients (female n = 32, 82.1%; median age: 49 years old, IQR = 29.0-56.0) were included. After three months of treatment with fremanezumab, ten out of 39 patients (25.6%) were considered responders. Four of the 11 patients who continued fremanezumab became responders at month 6, increasing the number of responders to 14 patients (35.9%). Responders received a median of 12 injections (IQR = 9.0-18.0) at the time of the analysis. After the last treatment, 13 patients (33.3%) remained responders. The number of mean monthly migraine days significantly decreased from 21.4 at baseline (IQR = 10.7-30.0) to 8.6 (IQR = 3.8-13.9) at the last follow-up. Painkillers intake and HIT-6 score were significantly reduced at the last follow-up. About 1/3 of patients with treatment refractory chronic migraine who have a disappointing response to erenumab and switch to fremanezumab, obtained a meaningful and sustained improvement of their migraine load over time, supporting the appropriateness of this therapeutic approach in clinical practice.

Keywords: Calcitonin gene-related peptide; Chronic migraine; Erenumab; Fremanezumab; Refractory migraine.

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Conflict of interest statement

GL has received speaker honoraria, funding for travel and has received honoraria for participation in advisory boards sponsored by Allergan, Novartis, Eli Lilly, TEVA and Lundbeck. He has received speaker honoraria, funding for travel from electroCore, Nevro Corp. and Autonomic Technologies. VC has received honoraria for participation in advisory boards sponsored by Novartis and speaker honoraria sponsored by Teva. BH has received speaker honoraria from Lundbeck. SR, MM and JB have nothing to declare. SS: personal fees as speaker or advisor: Abbott, Allergan-Abbvie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva. Research grants: Novartis. Fees for CME/education: Medscape, Neurodiem Ology Medical Education. Intellectual: president elect European Stroke Organisation, second vice president of the European Headache Federation, specialty chief editor in Headache and Neurogenic Pain for Frontiers in Neurology, associate editor for The Journal of Headache and Pain, assistant editor for Stroke. APA received speaker honoraria and funding for travel from Allergan, Eli Lilly and eNeura, honoraria for participation in advisory boards sponsored by Allergan and Eli Lilly, sponsorship for educational purposes from eNeura, Allergan, Autonomic Technologies and Novartis and an equipment grant from eNeura. RK has nothing to declare.

Figures

Fig. 1
Fig. 1
Patients’ pathway and response to fremanezumab after switching from erenumab. Number of injections and time between treatments are expressed in median
See this image and copyright information in PMC

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