Low discontinuation rates with preventative galcanezumab in a real-world setting

A real-world study showed that long-term galcanezumab has low discontinuation rates when used to prevent migraine episodes, and that these rates are lower compared with discontinuation rates among patients receiving traditional oral preventative medications.

TRIUMPH is an ongoing, prospective, 24-month, observational registry study of patients who are receiving preventative treatment for migraine, including galcanezumab and other traditional oral preventative medications. The registry includes adults with a diagnosis of migraine according to ICHD-3 and who initiated a new medication or who switched their prescription preventative medication as part of routine care. The main outcomes of TRIUMPH include treatment persistence, augmentation (combination of therapies), switching, and discontinuation. Dr Sait Ashina (Harvard Medical School, MA, USA) and colleagues reported interim 12-month results [1].

In total, 973 participants were included in the galcanezumab group and 1,138 in the traditional oral preventative medications group. Persistence rates were similar between groups (73.8% vs 73.4%), but discontinuation rates (10.0% vs 14.1%) and treatment switching rates (7.8% vs 10.5%) were lower with galcanezumab. Furthermore, there was a tendency for a higher proportion of participants to use combination therapy in the traditional oral medicines group compared with galcanezumab (8.1% vs 3.1%). Moreover, discontinuation due to “all causes” (17.8% vs 23.2%; P=0.0025) and due to “negative reasons” (12.7% vs 17.4%; P=0.0022) was significantly lower with galcanezumab. The most common reasons for discontinuation were no response (2.9%) and inadequate response (6.2%) with galcanezumab versus treatment intolerance (8.5%) and inadequate response (4.3%) with traditional oral preventative medications. In participants who switched medication, the most commonly used drugs in the second line were other CGRP-targeted monoclonal antibodies following galcanezumab, while those on traditional oral preventative medications mainly switched to another traditional oral medication.

The authors concluded that both discontinuation and combination rates were lower with galcanezumab 12 months after first-line or second-line drug initiation. The most commonly reported reasons for treatment discontinuation were insufficient response with galcanezumab and treatment intolerance with traditional oral preventative medications.

1. Ashina S, et al. Real-world treatment patterns of galcanezumab and traditional oral migraine preventives: 12-month results from the TRIUMPH study. 18^th European Headache Congress, 4–7 December 2024, Rotterdam, the Netherlands.

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Posted on 6 January 20256 January 2025