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

• Published in: Cephalalgia 2024-10, Vol.44 (10), p.3331024241288875
• Main Authors: Triller, Paul, Blessing, Virginia N., Overeem, Lucas H., Fitzek, Mira P., Hong, Ja Bin, Lange, Kristin S., Reuter, Uwe, Raffaelli, Bianca
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Calcitonin Gene-Related Peptide - antagonists & inhibitors; Calcitonin Gene-Related Peptide - immunology; Calcitonin Gene-Related Peptide Receptor Antagonists - therapeutic use; Cohort Studies; Female; Humans; Injections, Subcutaneous; Male; Middle Aged; Migraine Disorders - drug therapy; Receptors, Calcitonin Gene-Related Peptide - metabolism; Retrospective Studies; Treatment Outcome
• ISSN: 0333-1024; 1468-2982; 1468-2982
• DOI: 10.1177/03331024241288875

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. Graphical abstract This is a visual representation of the abstract.