Assessing Long-Term Benefit of Eptinezumab for Chronic Migraine: Amaal Starling, MD, FAHS, FAAN

WATCH TIME: 4 minutes

"At two years of treatment, there were 23% of individuals that were previously diagnosed with chronic migraine, that had zero monthly headache days taken from that [Migraine Disability Assessment] headache frequency as a data point."

For patients with migraine experiencing less than 4 monthly headache days (MHDs), preventive treatment may be optimized. Beyond a reduction in frequency, efficacy with preventive migraine treatment can be defined by significant improvements in headache severity and related disability (e.g., Migraine Disability Assessment [MIDAS]). A post hoc analysis of the PREVAIL study (NCT02985398) assessed MIDAS-derived headache frequency, severity, and associated disability in patients with chronic migraine treated with eptinezumab (Vyepti; Lundbeck), an FDA-approved anti-calcitonin gene-related peptide (CGRP) monoclonal antibody used for preventive migraine.

PREVAIL was an open-label phase 3 trial that assessed the long-term safety of eptinezumab in 128 patients with chronic migraine. In the trial, patients received eptinezumab 300 mg every 12 weeks for up to 8 doses, going up to 2 years of treatment. MIDAS was conducted every 12 weeks from baseline to week 84 and at the week 104 follow-up. All told, results from the post-hoc analysis reported that eptinezumab reduced MIDAS-derived headache frequency, pain severity, FSI, and disability over the 2-year study. Notably, many patients achieved less than 4 migraine headache days (MHDs), including an increase in patients reporting 0 MHDs from week 12 to week 104. These findings suggest an added benefit of continuing treatment with overtime and its ability to affect migraine utilizing novel, practical assessments.¹

These findings were recently presented at the 2024 American Headache Society (AHS) Annual Meeting, held June 13-16, in San Diego, California, by coauthor Amaal Starling, MD, FAHS, FAAN, and colleagues.² Following the meeting, Starling, an associate professor in the department of neurology at Mayo Clinic College of Medicine, sat down with NeurologyLive^® in an interview to discuss the significance of achieving less than 4 monthly headache days in the context of chronic migraine treatment. She also spoke about how the Frequency Severity Index helps in evaluating the effectiveness of eptinezumab. Furthermore, Starling talked about the implications of these findings on future preventive treatment strategies for chronic migraine.

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REFERENCES
1. Lundbeck to Present a Breadth of Migraine and Cluster Headache Data at the 66th Annual Scientific Meeting of the American Headache Society. News Release. Published June 13, 2024. Accessed June 28, 2024. https://www.newsroom.lundbeckus.com/news-release/2024/lundbeck-to-present-a-breadth-of-migraine-and-cluster-headache-data-at-the-66th-annual-scientific-meeting-of-the-american-headache-society
2. Blumenfeld A, Starling AJ, Kudrow D, et al. Long-term reductions in headache frequency, severity, and disability in patients with chronic migraine treated with eptinezumab: post hoc analyses of the PREVAIL study. Available at https://doi.org/10.1111/head.14716. Accessed June 28, 2024.