Effectiveness of Switching CGRP monoclonal antibodies in non-responder patients in the UAE: A retrospective study

Abstract

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promising effectiveness in migraine management compared to other preventative treatment options. Currently there are several studies related to the efficacy and tolerability of CGRP mAbs in the management of mgraine. However, many questions remain unanswered when it comes to switching between antibody classes as a treatment option in patients with migraine headaches. The present study seeks to explore and assess the treatment response to CGRP mAb in patients who have previously failed other CGRP mAbs.This was a retrospective, real-world, exploratory study. The participants included within the study were adult (≥18 years) patients diagnosed with migraine. Patients who were treated with two or more GCRP mAbs were retrospectively analyzed. Data was collected from one site, 53 patients with migraine headache switched between three CGRP mAb types (Eptinezumab, Erenumab, and Glacanezumb) due to lack of efficacy of the original prescribed CGRP mAb. Efficacy of switching between types of CGRP mAb’s was evaluated through documented MMD’s in patient diaries and clinical records. Non-parametric analysis was used to compare efficacy of the first six months of each prescribed medication. The analysis of efficacy demonstrated that some improvements were seen in both class switch cohorts (CGRP/R to CGRP/L and CGRP/L to CGRP/R). However, the most noticeable improvement in efficacy of the prescription switch was found in patients who switched between different medications of the CGRP/L class. Both chronic migraine and episodic migraine patients showed improved MMD’s, however chronic migraine patients demonstrated higher responsiveness of efficacy following this lateral switching, The safety of switching between CGRP classes was well observed as any adverse events presented pre-class switch did not lead to the discontinuation of treatment following the later switch. The findings of this study suggest that switching between different classes of CGRP mAbs is a potentially safe and clinically viable practice that may have some applications for those experiencing side effects on their current CGRP mAb or have suboptimal response. This is especially true for patients initiating treatment on ligand targeted CGRP mAb who experience side effects or lack of meaningful efficacy, as the ligand-ligand cohort seems to demonstrate the best outcome. Larger cohort studies and longer follow ups are needed to validate our findings.