Late Response to Anti-CGRP Monoclonal Antibodies in Migraine

ObjectivesTo assess the frequency and characteristics of late responders (>12 weeks) to monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP).MethodsThis is a multicenter (n = 16) prospective real-life study considering all consecutive adults with high-frequency or chronic migraine treated with anti-CGRP mAbs for =24 weeks. We defined responder patients with a =50% reduction from baseline in monthly migraine/headache days at weeks 9-12 and late responders as those achieving a =50% reduction only afterward.ResultsA total of 771 people with migraine completed & GE;24 weeks of anti-CGRP mAb treatment. Responders at 12 weeks were 65.6% (506/771) of the patients, while nonresponders were 34.4% (265/771). A total of 146 of the 265 nonresponders (55.1%) at 12 weeks responded afterward (late responders): they differed from responders for a higher BMI (+0.78, 95% CI [0.10; 1.45]; p = 0.024), more frequent treatment failures (+0.52, 95% CI [0.09; 0.95]; p = 0.017) and psychiatric comorbidities (+10.1%, 95% CI [0.1; 0.20]; p = 0.041), and less common unilateral pain, alone (-10,9%, 95% CI [-20.5; -1.2]; p = 0.025) or in combination with unilateral cranial autonomic symptoms (-12.3%, 95% CI [-20.2;-3.9]; p = 0.006) or allodynia (-10.7, 95% CI [-18.2; -3.2]; p = 0.01).DiscussionHalf of nonresponders to anti-CGRP mAbs at 12 weeks are indeed late responders. Efficacy of anti-CGRP mAbs should be assessed at 24 weeks while treatment duration should be extended beyond 12 months.

Automated summary

In a multicenter study assessing the use of anti-CGRP mAbs in patients with high-frequency or chronic migraine, it was found that half of the nonresponders at 12 weeks actually responded later. Efficacy of the treatment should be evaluated at 24 weeks and treatment duration extended beyond 12 months.