80% of patients reverse from chronic to episodic migraine on anti-CGRP antibodies

Real-life data showed that anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) are even more effective than what was found in randomised trials. In patients who failed on >3 preventive medication classes, anti-CGRP mAbs reversed chronic migraine to episodic migraine in about 60% of patients at 12 weeks, and in about 80% at week 48.

Dr Gabriella Egeo (IRCCS San Raffaele, Italy) said that, in randomised clinical studies, anti-CGRP mAbs shift chronic to episodic migraine in about half of patients after 12 weeks of treatment. The researchers wanted to know how this data compared with treatment results in real life, among patients who had previously failed at least 4 preventive medication classes. To this end, they set up the largest prospective cohort study of anti-CGRP mAbs ever conducted, in which 29 hospitals in Italy participated [1].

The study included 1,109 patients who had received >1 anti-CGRP mAbs dose (676 erenumab, 295 fremanezumab, and 138 galcanezumab) between 2019–2022. Of the 1,109 participants, 1,003 (90%) were registered as ‘medication overuse’. Reversion from chronic to episodic migraine and from medication overuse to no medication overuse was monitored at weeks 12, 24, and 48 in all centres. The primary endpoint was reversion from chronic to episodic migraine at week 12.

The primary endpoint was met by 71.8% of the participants. The researchers found that up to 80.8% of patients reverted from chronic to episodic migraine during follow-up (see Table). Moreover, 81.9–83.7% of patients reverted from medication overuse to no medication overuse from weeks 4 to 48 (see Table).

Table: Reversion from chronic to episodic migraine, and from medication overuse to no medication overuse [1]



Dr Egeo concluded that anti-CGRP mAbs without analgesic detoxification are highly effective in reverting migraine chronification as well as medication overuse. She added that, based on this data, the effectiveness of anti-CGRP mAbs is better than their efficacy.

1. Egeo G, et al. Reversion from CM to EM with anti-CGRP mAbs: a prospective, multicenter study on 1109 patients (the I-NEED study). EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.

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Posted on 7 September, 202327 March, 2024