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. 2024 Jun 3;25(1):90.
doi: 10.1186/s10194-024-01790-7.

Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies - insights from the German NeuroTransData registry

Ja Bin Hong  1 , Heike Israel-Willner  2   3 , Andreas Peikert  4   5 , Peter Schanbacher  6   7 , Viola Tozzi  6 , Monika Köchling  5   8 , Uwe Reuter  1   9 , Bianca Raffaelli  1   10 ; NTD Study Group
Affiliations

Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies - insights from the German NeuroTransData registry

Ja Bin Hong et al. J Headache Pain. .

Abstract

Background: Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway have shown good efficacy in migraine prophylaxis. However, a subset of patients does not respond to the first mAb treatment and switches among the available mAbs. The goal of this study is to characterize the switching pattern of migraine patients treated with anti-CGRP(-receptor, -R) mAbs, and to describe the headache burden of those who did not switch, switched once, and switched twice.

Methods: This study used real world data from the NeuroTransData Cohort, a registry of migraine patients treated at outpatient neurology clinics across Germany. Patients who had received at least one anti-CGRP(-R) mAb were included. Headache diaries were collected at baseline and during treatment, along with quality of life measures every three months. Results were summarized for the subgroups of patients who did not switch and those with one and two switches.

Results: Of the 655 eligible patients, 479 did not switch, 135 switched once, 35 twice, and 6 three or more times. The ≥ 50% response rates for monthly migraine days were 64.7%, 50.7%, and 25.0% for the no switch, one switch, and two switches groups in their last treatment cycles, respectively. Quality of life measures improved for the no switch and one switch groups, but not for the two switches group.

Conclusion: Patients who switched among anti-CGRP(-R) mAbs during the course of their treatment still benefited overall but to a lesser extent than those who did not switch. Treatment response in patients who switched twice was markedly lower compared to the no switch and one switch subgroup.

Keywords: Calcitonin-gene-related peptide; Migraine; Monoclonal antibody; Prophylaxis; Real-world experience.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Sankey diagram of switching patterns among erenumab, fremanezumab and galcanezumab
Fig. 2
Fig. 2
Results for the no switch subgroup. Mean monthly migraine days (MMD) during the first 6 months of treatment (A), percentage of patients achieving ≥ 50% reduction in MMD at 3 and 6 months (B), average HIT-6 (C) and MIDAS (D) scores at baseline, 3 and 6 months for the no switch subgroup. Error bars represent 95% confidence intervals
Fig. 3
Fig. 3
Results for the one switch subgroup. Mean monthly migraine days (MMD) during the first 6 months (A), percentage of patients achieving ≥ 50% reduction in MMD at 3 and 6 months (B), average HIT-6 (C) and MIDAS (D) scores at baseline, 3 and 6 months during the first and second treatment cycles of the one switch subgroup. Error bars represent standard errors of the mean
Fig. 4
Fig. 4
Results for the two switches subgroup. Mean monthly migraine days (MMD) during the first 6 months (A), percentage of patients achieving ≥ 50% reduction in MMD at 3 and 6 months (B), average HIT-6 (C) and MIDAS (D) scores at baseline, 3 and 6 months during the first, second, and third treatment cycles of the two switches subgroup. Error bars represent standard errors of the mean
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