Article Text

Download PDFPDF

5PSQ-129 Switching between anti-calcitonin gene related peptide monoclonal antibodies in migraine
Free
  1. C Ribera Puig1,
  2. P Cleries Rovira1,
  3. N Mas Bauza1,
  4. S Gamarra Calvo1,
  5. JC Rojas Alvero2,
  6. J Campdelacreu Fumado2,
  7. M Comas Sugranes1,
  8. M Alonso Moreno1,
  9. M Muñoz Bolaño1,
  10. N Padullés Zamora3
  1. 1Bellvitge University Hospital, Pharmacy, Barcelona, Spain
  2. 2Bellvitge University Hospital, Neurology, Barcelona, Spain
  3. 3Bellvitge University Hospital, Pharmacy- Bellvitge Biomedical Research Institute Idibell, Barcelona, Spain

Abstract

Background and Importance Monoclonal antibodies (mAb) against calcitonin gene related peptide (anti-CGRP) and its receptor (anti-CGRP-receptor) are effective in the prophylaxis of migraine. However, studies to determine effectiveness and safety on switching between them in non-responders are scarce.

Aim and Objectives To evaluate the real-world clinical effectiveness and safety of mAb switch in migraine patients.

Material and Methods Retrospective cohort study of adult patients who switched between mAb in a tertiary hospital from December 2019 until September 2022. Sociodemographic and clinical data were recorded. Outcome measures: the reduction of Headache Impact Test (HIT-6) scale punctuation and the reduction of monthly migraine days.

Results We analysed 147 patients treated with anti-CGRP or anti-CGRP-receptor. Among these, 20 patients (13.6%) switched between mAb and had at least one follow-up visit after switching. 16 patients (80%) suffered from chronic migraine (CM) with a baseline median days of migraine a month of 15 [13-24], median Regicor scale of 2% [1-3%] and median HIT-6 of 67 [62.5-72.3]. 19 (95%) were female.

Out of these 20 patients, 15 (75%) started with Erenumab and 5 (25%) with Galcanezumab. First mAb switching was performed after a median of 7.4 months treatment [5.9-11.8] (12 from Erenumab to Galcanezumab; 3 from Erenumab to Fremanezumab; 2 from Galcanezumab to Erenumab and 3 from Galcanezumab to Fremanezumab). 5 patients required a second switch, and one received a third mAb. Reasons for first switching: 12 (60%) non-response, 7 (35%) loss of response and 1 (5%) adverse event. 1 patient (5%) discontinued mAb treating during the study period due to lack of effectiveness.

Median reduction in HIT-6 after first and second switching was-2 [-11.5-0],and -3.5 [-11.8-0], respectively. Median reduction of monthly migraine days after first, and second switching was -4.15 [-7-0] and-4.8 [-6.5 to -0.6], respectively.

Constipation (38.7%) and itchiness (3.2%) were the most frequent adverse events during the study period.

Conclusion and Relevance Our findings in 20 treatment-resistant patients indicated that switching between CGRP mAbs could be beneficial to some non-responders to a initial mAb.

Conflict of Interest No conflict of interest

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.