Patterns of response to anti-calcitonin gene-related peptide monoclonal antibodies during first 6 months of treatment in resistant migraine patients: Impact on outcome

Background and purpose: The response pattern to monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAbs) shown in migraine prevention clinical trials is not always reproducible at an individual level. This study was undertaken to describe patterns of start and consistency of the response to anti-CGRP MAbs during the first 6 months of treatment and the association with baseline clinical characteristics.Methods: This is a prospective clinical cohort observational study. We included migraine patients treated with erenumab or galcanezumab evaluated at baseline and after 3 and 6 months (M3, M6) of treatment. The response was categorized according to reduction in monthly headache days (MHD): Sustained-response (SustainedR, =50% at M3 and M6), Short-Response (ShortR, M3 =50% and M6 <50%), Late-Response (LateR, M3 <50% and M6 =50%), Limited-Response (LimitedR, 25%-50% at M3 and M6), and No-Response (NoR, <25% at M3 and M6). Response patterns were compared at baseline and with outcome variables at M3 and M6.Results: We included 357 patients with a headache frequency of 21.0 (interquartile range = 16.0-28.0) MHD, and 84.0% (300/357) were chronic migraine. The distribution according to response pattern was 37.0% (110/297) SustainedR, 16.8% (50/297) LateR, 10.4% (31/297) ShortR, 22.6% (67/297) LimitedR, and 13.1% NoR (39/297). The SustainedR and LateR groups showed statistically significant anxiety and depression score reduction at M3 and M6 compared to the other groups.Conclusions: Initial response to anti-CGRP MAbs is not consistent in all patients. Persistence of anxiety and depression might be associated with lower response rates at M6.

Automated summary

This study examines the patterns of response to anti-CGRP MAbs in migraine patients during the first 6 months of treatment and its association with baseline clinical characteristics. The initial response to anti-CGRP MAbs varies among patients, and persistence of anxiety and depression may affect treatment response at 6 months.