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. 2024 Oct;44(10):3331024241288875.
doi: 10.1177/03331024241288875.

Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study

Paul Triller  1 , Virginia N Blessing  1 , Lucas H Overeem  1 , Mira P Fitzek  1 , Ja Bin Hong  1 , Kristin S Lange  1   2 , Uwe Reuter  1   3 , Bianca Raffaelli  1   2
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Free article

Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study

Paul Triller et al. Cephalalgia. 2024 Oct.
Free article

Abstract

Background: Migraine patients unresponsive to calcitonin gene-related peptide (CGRP)(-receptor, -R) monoclonal antibodies (mAbs) may benefit from switching between CGRP(-R) mAbs. However, some patients do not tolerate or respond to any subcutaneous mAbs. This study evaluates the efficacy of the intravenous CGRP mAb eptinezumab in these therapy-refractory patients.

Methods: In this retrospective cohort study, patients with migraine who previously failed erenumab and at least one CGRP mAb (fremanezumab and/or galcanezumab) received eptinezumab 100 mg, followed by a second dose of 100 mg or 300 mg after 12 weeks. Monthly headache days, monthly migraine days, acute medication days, and migraine pain intensity were recorded from standardized headache diaries during the four weeks before the first infusion (baseline), and during weeks 9-12 and 21-24 of treatment. Patient-reported outcomes were analyzed at baseline, weeks 12, and 24.

Results: From January 2023 to February 2024, 41 patients received eptinezumab 100 mg. Of these, 38 (93%) received a second infusion after 12 weeks, with 29 (71%) increasing the dose to 300 mg. The percentage of patients with a ≥30% reduction rate in monthly migraine days was 23.1% at week 12 and 29.7% at week 24. Monthly migraine days decreased from 16.3 ± 8.0 at baseline to 15.4 ± 8.1 days during weeks 9-12 and 14.4 ± 8.0 days during weeks 21-24 (p = 0.07). During weeks 21-24, 38.5% reported a clinically meaningful reduction in HIT-6 scores and 52.4% in MIDAS scores. No adverse events were reported.

Conclusions: Eptinezumab may be an effective and well-tolerated option for some treatment-refractory migraine patients unresponsive to subcutaneous CGRP-(R) mAbs.

Keywords: Migraine; calcitonin gene-Related peptide; daily headache; monoclonal antibodies; preventive treatment; refractory migraine; switch.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: P.T. reports personal fees from Abbvie. V.N.G. has nothing to disclose. L.H.O. has nothing to disclose. M.P.F. reports personal fees from Teva. J.B.H. has nothing to disclose. K.S.L. reports personal fees from Teva. U.R. reports personal fees from Amgen, Allergan, Abbvie, Lilly, Lundbeck, Novartis, electroCore, Medscape, StreaMedUp, and Teva, and research funding from Novartis. B.R. reports personal fees from Abbvie/Allergan, Eli Lilly, Lundbeck, Novartis, Perfood and Teva, and research funding from Lundbeck and Novartis.

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