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Switching Between Anti-CGRP Monoclonal Antibodies Reduces Headache Days in Non-Responders
Key Takeaways
- Switching between anti-CGRP mAbs significantly reduced monthly headache days in patients unresponsive to initial treatment.
- Subgroup analysis showed no significant difference in efficacy between maintaining or changing the target mechanism.
The switch from 1 anti-CGRP monoclonal antibody to another led to a significant reduction in monthly headache days, regardless of target mechanism, dose history, or time between treatments.
Alex Jaimes, MD
(Credit: X)
A recently published retrospective study conducted at a tertiary headache center showed that switching between monoclonal antibodies (mAbs) targeting calcitonin gene–related peptide (CGRP) or its receptor significantly reduced monthly headache days (MHDs) in patients with migraine who did not respond to initial anti-CGRP treatment.1
In the study, researchers analyzed clinical records of patients diagnosed with migraine2 who were treated with anti-CGRP mAbs between January 2020 and March 2024. Among the 185 patients included in the 3-month analysis part of the study, the median MHDs decreased from 27.0 at baseline (IQR: 16.1-30.0; range 5.0-30.7) to 21.0 (IQR: 10.0-30.0; range: 0.0-30.0; P <.001). Findings then showed that among the 123 patients evaluated at the 6-month part in the study, MHDs further declined to 20.0 (IQR: 10.0-30.0; range: 0.0-31.0; P <.001).
Published in Headache, researchers performed a subgroup analysis to determine whether switching the mechanism of action, like from targeting CGRP to targeting its receptor or vice versa, impacted efficacy. At baseline, authors reported that patients who maintained the same target had a median MHD of 28.0 (IQR: 16.2-30.0; range: 5.0-31.0), compared with 27.0 (IQR: 6.0-31.0; range: 6.0-31.0) for those who changed targets.
At 3 months into the analysis, researchers observed that the median MHDs were 23.0 (IQR: 10.0-30.0; range: 0.0-31.0) for those who maintained the same mechanism and 19.0 (IQR: 11.0- 30.0; range: 1.0-31.0) for those who changed it (P = .144). At month 6, investigators then observed that the median MHDs were 24.0 (IQR: 11.0-30.0; range: 0.0-31.0) in the same-target group and 17.0 (IQR: 10.0-30.0; range: 3.0-31.0) in the changed-target group (P = .170).
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Conducted by lead author Alex Jaimes, MD, a neurologist at the Headache Unit in the Department of Neurology at Fundación Jiménez Díaz University Hospital in Madrid, Spain, the study also assessed predictors of achieving at least a 50% reduction in MHDs at 3 months. All told, there was no association between the number of doses of the first mAb and treatment response (OR, 1.0; 95% CI, 1.0-1.1; P = .189), nor was there a significant influence of the inter-treatment interval (OR, 1.0; 95% CI, 0.9-1.1; P = .914).
This retrospective study had limitations, including incomplete medical records and inconsistent headache diary data. Missing outcomes were addressed with the last observation carried forward method, which may have introduced bias. Some key measures like disability and medication use were not consistently recorded. Treatment switches because of adverse events and the lack of a control group could affect the focus on the effectiveness. Authors also noted that patients with medication-overuse headache were not analyzed separately.
Overall, the findings revealed that switching between anti-CGRP mAbs led to a statistically significant reduction in MHDs at both 3 and 6 months for patients with migraine. Authors noted that the findings were consistent regardless of whether the antibody target was changed, how many doses of the first antibody were given, or how much time passed between treatments. Thus, these results may support the use of switching to anti-CGRP therapies as an effective option for patients who do not initially respond to treatment.
