Over a third of patients responds late to CGRP antibodies

Calcitonin gene-related peptide (CGRP) monoclonal antibodies elicited a late therapeutic response in over one-third of migraine patients who were initially considered non-responders at 12 weeks, in a real-life study with 912 participants. The authors advocate to extend the efficacy evaluation of CGRP inhibitors to 6 months.

Migraine patients usually have an early response, within 12 weeks of treatment, to CGRP inhibitors. A real-life cohort study, presented by Dr Cinzia Aurilia (University of Florence, Italy), was set up to establish the late response rate (beyond 12 weeks of treatment) in all consecutive patients who were treated with a CGRP inhibitor for ≥12 months over a 3-year period [1].

Included were 912 patients from 16 specialised centres with either chronic migraine (CM; n=690) or high-frequency episodic migraine (HFEM; n=222). Patients were treated with erenumab (n=789), fremanezumab (n=65), or galcanezumab (n=58). The primary endpoint was the proportion of late responders (≥50% response >12 weeks) and the secondary endpoint was the estimated median week of response in these patients.

Overall, 352 patients (38.6%) were non-responders at week 12. From the erenumab, fremanezumab, and galcanezumab receivers, 43.6% (344), 21.5% (14), and 24.1% (14) were non-responders, respectively. Of these non-responders, just over a third (36.4%; n=128) had a response at a later stage: erenumab 33.1% (n=114), fremanezumab 35.7% (n=5), galcanezumab 64.2% (n=9). Rates of responders, non-responders, and late responders for all 3 therapies are shown in the Figure. In the group of late responders, a ≥50% response was seen after a median of 20 weeks (IQR 4–24) of treatment: 20, 16, and 20 weeks in the erenumab, fremanezumab, and galcanezumab group, respectively.

Figure: Rates of responders, non-responders, and late responders for erenumab, fremanezumab, and galcanezumab [1]

Pts, patients.

Based on these results, the authors propose to continue evaluating the efficacy of a CGRP inhibitor for up to 6 months and to align reimbursement policies accordingly.

1. Aurilia C, et al. Late response to anti-CGRP (calcitonin gene-related peptide) monoclonal antibodies: implication for clinical practice. OPR-050, EAN 2022, 25–28 April, Vienna, Austria.

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Posted on 22 August, 2022