Telemedicine Produces Meaningful Migraine Improvement, Galcanezumab Shows No Wearing Effect, CGRPs All Significant Improve MMDs

This week Neurology News Network covered a number of presentations at the 2021 American Headache Society 63rd Scientific Annual Meeting, including findings that show clinically meaningful improvements from telemedicine, the lack of wearing off effect from galcanezumab, and the relative efficacy of ubrogepant compared to other CGRPs.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus. This week’s episode is centered around the 2021 American Headache Society 63rd Scientific Annual Meeting.

Using a retrospective review that assessed Headache Impact Test-6 (HIT-6) scores over a year-long period, researchers concluded that clinically meaningful improvement in migraine can be achieved with the exclusive use of synchronous video telemedicine visits for migraine care. Brad Torphy and colleagues evaluated the use of synchronous video telemedicine in the management of migraine from the initial visit onward for 73 patients who had a telemedicine visit from March 3, 2020, to March 18, 2021. When comparing initial and follow-up HIT-6 assessment scores, researchers recorded a 6-point change. An improvement in HIT-6 score was observed in 80% of patients who met screening criteria at follow-up. Notably, 60% of those patients with improvement had a reduction of at least 6 points or more, which the authors noted met a threshold that was previously identified as clinically meaningful in patients with chronic migraine.

Recent data from a post-hoc analysis of several studies of galcanezumab in people with migraine suggest that rates of individual patients meeting the threshold of “wearing off” of treatment efficacy were low with no statistically significant differences observed among placebo and galcanezumab dose groups. Ailani and colleagues analyzed individual patient-level data from 4 double-blind, placebo-controlled phase 3 studies: EVOLVE-1 and EVOLVE-2 of high frequency episodic migraine (EM), REGAIN of chronic migraine (CM), and CONQUER of CM and EM. The investigators found that rates of wearing off in EM populations were comparable among placebo and galcanezumab-treated patients, with 4% to 7% of patients meeting the predefined criteria. In the EVOLVE trials, in which 3 months of data were available, less than 1% of patients met the criteria during all 3 months.

A comprehensive systematic literature review evaluating the relative efficacy of rimegepant (Nurtec ODT; Biohaven), atogepant (Allergan), and monoclonal antibody (mAb) treatments for the prevention of migraine showed generally similar effects when compared to each other.Overall, all of the treatments observed showed significantly favorable differences compared to placebo for both change in MMDs and number achieving at least a 50% reduction in baseline MMDs. Results for change in MMDs vs placebo ranged in magnitude from eptinezumab 100 mg to galcanezumab 240 mg while rimegepant had a difference vs placebo of -0.90. Atogepant 60 mg daily represented the lowest risk difference estimate vs placebo for achieving at least a 50% reduction in baseline MMDs, while the magnitude reached the greatest for galcanezumab 120 mg (23.40%). Rimegepant had a difference vs placebo of 12.90%.

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